1
|
Claus JDP, Spinella Almeida M, Correia Lopes HJ. The Use of Bone Substitute Blocks in Minimally Invasive Orthognathic Surgery: Enhancing Jaw Stability and Healing. J Craniofac Surg 2024:00001665-990000000-01898. [PMID: 39248721 DOI: 10.1097/scs.0000000000010628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024] Open
Abstract
This study aims to evaluate the use of bone substitute blocks (BSBs) in minimally invasive orthognathic surgery for the maxilla, mandible, and chin, highlighting their impact on jaw stability and bone healing. A retrospective analysis was conducted on 47 consecutive patients (33 females, 14 males; mean age: 27 y) who underwent bimaxillary advancement surgery. Procedures employed the minimally invasive orthognathic surgery approach. Bovine BSBs (Bio-Oss Collagen) were used to fill gaps in all cases. Postoperative follow-up included computed tomography scans at immediate and 1-year intervals. All patients achieved the desired clinical outcomes without complications such as wound dehiscence, infection, or nonunion. Visual Analog Scale scores indicated high levels of bone formation, with mean scores of 9.1 in the chin, 8.5 in the maxilla, and 7.9 in the mandible. The study supports the routine use of BSBs in orthognathic surgeries, though further research is needed to validate these findings and explore long-term outcomes.
Collapse
|
2
|
Yoshida S, Felix M, Colin E, Sarhan FR, Dakpé S. Reconsideration of the alar base cinch suture technique involving the perinasal musculature: an in-depth review. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00250-9. [PMID: 39153888 DOI: 10.1016/j.ijom.2024.07.019] [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: 01/26/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024]
Abstract
Orthognathic surgery affects both function and aesthetics. An important aesthetic complication is the nasal alteration that can result from Le Fort I osteotomy. A common method for countering this complication is the alar base cinch suture technique. Although the method for this suture has been standardized, the results vary and are inconsistent; further improvements are therefore required. The objective of this study was to review the literature data on the alar base cinch suture technique and associated results. In this review, the PubMed, Ovid, and Ichushi-Web electronic databases were searched using logical combinations of keywords related to the perinasal musculature and alar base cinch suture technique. Following screening of the results, 42 publications were included. The review findings prompted several conclusions. The anatomy of the myrtiformis muscle and depressor septi nasalis may differ between ethnicities, and it is essential to take certain factors related to ethnicity into account when implementing the alar base cinch suture technique. It is also important to consider factors such as the patient's aesthetic preferences.
Collapse
Affiliation(s)
- S Yoshida
- UR 7516 Laboratoire CHIMERE, University of Picardie Jules Verne, Amiens, France; Institut Faire Faces, Amiens, France; Maxillofacial Surgery, CHU Amiens-Picardie, Amiens, France; Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan.
| | - M Felix
- UR 7516 Laboratoire CHIMERE, University of Picardie Jules Verne, Amiens, France; Institut Faire Faces, Amiens, France
| | - E Colin
- UR 7516 Laboratoire CHIMERE, University of Picardie Jules Verne, Amiens, France; Institut Faire Faces, Amiens, France; Maxillofacial Surgery, CHU Amiens-Picardie, Amiens, France
| | - F R Sarhan
- UR 7516 Laboratoire CHIMERE, University of Picardie Jules Verne, Amiens, France; Institut Faire Faces, Amiens, France; Physiotherapy School, CHU Amiens-Picardie, Amiens, France
| | - S Dakpé
- UR 7516 Laboratoire CHIMERE, University of Picardie Jules Verne, Amiens, France; Institut Faire Faces, Amiens, France; Maxillofacial Surgery, CHU Amiens-Picardie, Amiens, France
| |
Collapse
|
3
|
Aihara T, Yazaki M, Okamoto D, Saito S, Suzuki H, Nogami S, Yamauchi K. Changes in three-dimensional nasal morphology according to the direction of maxillary movement during Le Fort I osteotomy. J Plast Reconstr Aesthet Surg 2024; 98:10-17. [PMID: 39216185 DOI: 10.1016/j.bjps.2024.08.045] [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: 03/06/2024] [Revised: 08/03/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Le Fort I (LFI) osteotomy is commonly performed by orthognathic surgeons; however, postoperative changes in nasolabial morphology are of concern. Several factors influence such changes, but it is difficult to accurately predict the postoperative results. This study evaluated the three-dimensional (3D) morphological changes in the nasal region according to the different directions of maxillary movement during LFI osteotomy. MATERIALS AND METHODS Forty-one patients who underwent LFI osteotomies were included. All patients were divided into maxilla-up (Group U: 20 patients) and maxilla-forward (Group F: 21 patients) groups. Soft tissue morphologies were determined preoperatively and 3 or 6 months postoperatively using an optical 3D scanner. All datasets were evaluated in terms of volume changes in nine subregions and changes in linear measurements around the nasal area. RESULTS Both groups exhibited increased nasal volumes after surgery in the order of the three upper, three central, and three lower subregions. The change in volume of the central nasal region tended to be greater in Group U than that in Group F. CONCLUSION We evaluated 3D morphological changes in the nasal region according to the direction of maxillary movement during LFI osteotomy. Group U exhibited a large change in the volume of the central nasal region.
Collapse
Affiliation(s)
- Tomoki Aihara
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Mai Yazaki
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Daigo Okamoto
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Shizu Saito
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hikari Suzuki
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| |
Collapse
|
4
|
Sabri H, Tehranchi A, Sarkarat F. 3-dimensional analysis of nasal soft tissue alterations following maxillary Lefort I advancement with and without impaction using 3D photogrammetry scanner. Oral Maxillofac Surg 2024; 28:111-123. [PMID: 36322249 PMCID: PMC9628311 DOI: 10.1007/s10006-022-01121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE This study was designed to investigate the changes in nasal soft tissue following maxillary Lefort I advancement with and without impaction in subjects presenting a skeletal class III malocclusion, using a 3D photogrammetry scanner. MATERIALS AND METHODS Patients with class III malocclusion undergoing Lefort I advancement with and without impaction and bilateral sagittal split osteotomy with the standard technique were included in this study. Patients were divided into two groups: maxillary Lefort I advancement alone (group 1) and combined with impaction (group 2). Facial soft tissue landmarks of the nose including nasal height (NH), nasal length (NL), nasal tip projection (NTP), alar width (AW), alar base width (ABW), subalar width (Sbal), nasolabial angle (NLA), nasofrontal angle (NFA), and columella inclination (CI) before and at least 4 months after surgery were obtained by a 3D scanner. RESULTS Twenty-one patients were included in this study (Group 1: 11 and Group 2: 10). NH, NTP, and NL decreased significantly in both groups following surgery. In addition, Sbal decreased only in group 2. On the other hand, NLA and CI increased significantly in group 2. The inter-group comparison revealed a statistically significant difference in the alterations in NH, NL, and CI between the two groups. CONCLUSION Changes in the nose soft tissue occurred after both surgeries, but their type and extent were different. Actions taken to reduce unwanted changes need to be further investigated. To evaluate the changes, 3D photogrammetry scan is a feasible imaging technique that can be used, providing numerous benefits.
Collapse
Affiliation(s)
- Hamoun Sabri
- Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113 Iran
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI USA
| | - Azita Tehranchi
- Dental Research Center, Dental Research Institute, Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Cranio-Maxillofacial Research Center, Dentistry Branch of Islamic, Azad University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, Gulf Medical University, Sharjah, UAE
| |
Collapse
|
5
|
Lin HH, Kuo JC, Lo LJ, Ho CT. Optimizing Orthognathic Surgery: Leveraging the Average Skull as a Dynamic Template for Surgical Simulation and Planning in 30 Patient Cases. J Clin Med 2023; 12:7758. [PMID: 38137827 PMCID: PMC10743958 DOI: 10.3390/jcm12247758] [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: 11/07/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our clinical experience. We enrolled 30 consecutive Taiwanese patients (18 females and 12 males) who underwent two-jaw orthognathic surgery with surgical simulation, utilizing the average skull template for planning. Results indicate the method's applicability and precision. By adhering to the surgical plan, post-operative outcomes closely aligned with the average skull template, showing negligible deviations of less than 2 mm. Moreover, patients expressed high satisfaction with post-surgery facial changes, with the chin appearance receiving the highest satisfaction scores, while the lowest scores were attributed to nose appearance. Notably, the substantial change in lower jaw position post-mandibular setback surgery contributed to increased satisfaction with the chin position. In conclusion, this study does not seek to replace established surgical planning methods, but underscores that utilizing an average skull as a surgical design template provides a viable, accurate, and efficient option for OGS patients.
Collapse
Affiliation(s)
- Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan;
| | - Jyun-Cheng Kuo
- Dental Department of TuCheng Hospital, New Taipei Municipal, New Taipei City 236, Taiwan;
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan;
| | - Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| |
Collapse
|
6
|
Moroi A, Takayama A, Gomi K, Ono S, Yoshizawa K, Ueki K. Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy. J Craniofac Surg 2023; 34:e572-e576. [PMID: 37246292 DOI: 10.1097/scs.0000000000009402] [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: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 05/30/2023] Open
Abstract
This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.
Collapse
Affiliation(s)
- Akinori Moroi
- Division of Clinical Medicine, Department of Oral and Maxillofacial Surgery, Graduate Faculty of Interdisciplinary Research, University of Yamanashi
| | | | | | | | | | | |
Collapse
|
7
|
Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques. J Craniomaxillofac Surg 2021; 50:107-113. [PMID: 34802886 DOI: 10.1016/j.jcms.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to evaluate the nasolabial soft tissues effects in three different Le Fort I osteotomy techniques using cone beam computed tomography (CBCT) evaluation of three-dimensional (3D) volume surfaces. A retrospective study was designed, and three groups were evaluated: group 1, patients who underwent conventional Le Fort I osteotomy; group 2, patients who underwent subspinal Le Fort I osteotomy; and group 3, patients who underwent conventional Le Fort I osteotomy with ANS recontouring or removal. CBCT evaluation was performed at two time points: T0, 1 week before surgery; T1, 6 months after surgery. A total of 90 patients were enrolled in this study (group 1: 30; group 2: 30; group 3: 30). Mean maxillary advancement was 4.26 mm. For group 1, mean change in inter-alar width was 2.29 ± 1.57 mm (minimum -2mm; maximum 6.1 mm; for group 2 it was 1.20 ± 1.56 mm (minimum -1.7 mm; maximum 5.9 mm), and for group 3 was 1.84 ± 1.76 mm (minimum -2.3 mm; maximum 5.9 mm). For group 1, mean change in alar base width was 1.69 ± 2.32 mm (minimum -4.8 mm; maximum 6,1 mm); in group 2 it was 0.85 ± 2.08 mm (minimum -4mm; maximum 6 mm), and group 3 was 1.21 ± 1.83 mm (minimum -2mm; maximum 5 mm). Results showed statistically significant differences in nasolabial area (P < 0.001). Within the limitations of the study it seems that subspinal Le Fort I osteotomy should be preferred when the priority is to avoid changes to the nasolabial region.
Collapse
|