1
|
Alqahtani KA, Jacobs R, Da Costa Senior O, Politis C, Shaheen E. Recommendations to minimize tooth root remodeling in patients undergoing maxillary osteotomies. Sci Rep 2024; 14:13686. [PMID: 38871741 DOI: 10.1038/s41598-024-62059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.
Collapse
Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Oliver Da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Yun Y, Kurasawa S, Morita M, Kawachi R, Murata H, Sawada S, Kojima Y, Yagi M, Asako M, Iwai H. Postoperative hemorrhage after Le Fort I osteotomy hemostasis with angiographic embolization: report of two cases. J Surg Case Rep 2023; 2023:rjad663. [PMID: 38111488 PMCID: PMC10725792 DOI: 10.1093/jscr/rjad663] [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] [Received: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
This study reported two cases of acute life-threatening hemorrhage after Le Fort I osteotomy. In both cases, computed tomography and angiography revealed damage to the descending palatine artery, which was successfully treated by angiographic embolization. Although massive hemorrhage after Le Fort I osteotomy is rare, acute hemorrhage from the postoperative area may occur. Angiographic embolization is useful in cases of such hemorrhage from the posterior nasal cavity where endoscopic hemostasis is not possible.
Collapse
Affiliation(s)
- Yasutaka Yun
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shiro Kurasawa
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mizuki Morita
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Risaki Kawachi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hideyuki Murata
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shunsuke Sawada
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuka Kojima
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masao Yagi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mikiya Asako
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hiroshi Iwai
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| |
Collapse
|
3
|
Harjunpää R, Grann A, Saarikko A, Heliövaara A. Rhinoplasty and Le Fort I Maxillary Osteotomy in Cleft Patients. J Craniofac Surg 2023:00001665-990000000-01234. [PMID: 37983115 DOI: 10.1097/scs.0000000000009873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Cleft patients often need orthognathic surgery to correct maxillary hypoplasia and rhinoplasty to correct nasal deformity. Rhinoplasty can be performed as a staged procedure after orthognathic surgery or simultaneously with maxillary osteotomy. AIM The authors evaluated need for and complications of staged and simultaneous rhinoplasties in patients with different cleft types undergoing maxillary osteotomy. PATIENTS AND METHODS This retrospective study examined 99 (54 females) consecutive nonsyndromic patients with cleft lip/palate [23 bilateral cleft lip and palate (BCLP), 51 unilateral cleft lip and palate (UCLP), and 25 cleft palate (CP)] with a mean age of 17.8 (range: 11.5-45.3) years who had undergone Le Fort I maxillary advancement or bimaxillary osteotomy at the Cleft Palate and Craniofacial Center, Helsinki University Hospital, Finland, between 2002 and 2016. Medical charts were accessed through the hospital's archives and database. RESULTS Of patients who underwent maxillary osteotomy, 45% (45/99) needed rhinoplasty (14 BCLP, 27 UCLP, and 4 CP). A significant difference (P<0.01) existed in the need for rhinoplasty between different cleft types, those with BCLP and UCLP needing the most operations (60% and 53%). In 20 patients (20%), rhinoplasty was performed simultaneously with maxillary osteotomy, and in 25 patients (25%) in a second operation after osteotomy. The overall complication rate was 14%. No difference existed in complication rate in patients with or without simultaneous rhinoplasty. CONCLUSIONS Of cleft patients who underwent maxillary osteotomy, 45% needed rhinoplasty. Patients with BCLP and UCLP needed rhinoplasty most often. Staged and simultaneous procedures were almost equally common with similar complication rates.
Collapse
Affiliation(s)
- Roni Harjunpää
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | | | | |
Collapse
|
4
|
Moroi A, Iguchi R, Yoshizawa K, Ueki K. Sphenoid Sinus Foreign Body After Le Fort I Osteotomy. J Craniofac Surg 2023:00001665-990000000-01152. [PMID: 37934953 DOI: 10.1097/scs.0000000000009830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/14/2023] [Indexed: 11/09/2023] Open
Abstract
This report describes a rare case of a foreign body in the sphenoid sinus from the tip of an osteotome, which was lodged during the Le Fort I osteotomy. After surgery, a 2-mm-diameter round-shaped foreign body was seen as an opaque image in the right sphenoid sinus on computed tomography. The tip of the broken osteotome (Bauer) was confirmed after the intraoperative instruments were investigated. The foreign body was removed using an interventional endoscope and navigation computed tomography, and a good prognosis was obtained.
Collapse
Affiliation(s)
- Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Shimokato, Chuoshi, Japan
| | | | | | | |
Collapse
|
5
|
Kotaniemi KVM, Suojanen J, Palotie T. Complications and Associated Risk Factors for Bimaxillary Osteotomies: A 15-Year Single-center Retrospective Study. J Craniofac Surg 2023; 34:2356-2362. [PMID: 37747239 DOI: 10.1097/scs.0000000000009736] [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: 01/17/2023] [Accepted: 07/31/2023] [Indexed: 09/26/2023] Open
Abstract
AIM The aim of this study was to retrospectively investigate the risk factors and their association on bimaxillary osteotomies to be able to improve patient selection and bimaxillary osteotomy planning. MATERIAL AND METHODS Patients treated with a bimaxillary osteotomy were included in the study. The complications were collected retrospectively from the patient data records. The effects of certain predictor variables on complication rates were also studied. RESULTS Sixty-one patients (48.0%) suffered from peri- or postoperative complications, or both. Twenty-five various perioperative complications were reported on 25 patients (19.6%) and 63 postoperative complications on 46 patients (36.2%). Ten patients (7.8%) suffered from both perioperative and postoperative complications. The effect of various predictor variables (sex, age, general health, type of malocclusion, surgery planning, use of bone grafts, and type of maxillary or mandibular movement) on complications was investigated, but we could not find any single factor to affect significantly on complication rate. CONCLUSION Both perioperative and postoperative complications are common in bimaxillary surgery, which must be noted in patient preoperative information. However, life-threatening complications are rare. Patient profile, bone grafting, type of osteosynthesis, or segmentation of the maxilla do not seem to affect the complication risk.
Collapse
Affiliation(s)
- Karoliina V M Kotaniemi
- Department of Oral and Maxillofacial Diseases, Head and Neck Center Helsinki University Hospital, Helsinki
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki
| | - Juho Suojanen
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillo-Facial Surgery, Lahti, Finland
| | - Tuula Palotie
- Department of Oral and Maxillofacial Diseases, Head and Neck Center Helsinki University Hospital, Helsinki
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki
| |
Collapse
|
6
|
Osorio J, Martinez D, López JP, Gonzalez LV. Endoscopically Assisted LeFort I Osteotomy for Minimally Invasive Orthognathic Surgery: A Technical Note. J Craniofac Surg 2023; 34:1862-1863. [PMID: 37220660 DOI: 10.1097/scs.0000000000009350] [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: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 05/25/2023] Open
Abstract
Minimally invasive surgery in orthognathic surgery has gained popularity in recent years. This is mainly due to the benefit to the patient of achieving a better postoperative period and a faster recovery. However, one of the main difficulties is the lack of direct vision, which is a concern for the surgeon. For this reason, this technical note aims to propose endoscopically assisted LeFort I osteotomy for MI orthognathic surgery.
Collapse
Affiliation(s)
- Jose Osorio
- Oral and Maxillofacial Surgeon, Private Practice
| | | | - Juan P López
- Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá, Oral and Maxillofacial Surgery Program, Universidad El Bosque
| | - Luis V Gonzalez
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana; Researcher, Institución Universitaria Colegios de Colombia, Bogotá, Colombia
| |
Collapse
|
7
|
Joseph MM, Jain NS, DeLong MR, Ozaki W. Association Between Maxillary Segmentation and Perioperative Complications in Le Fort I Osteotomy. J Craniofac Surg 2023; 34:1705-1708. [PMID: 37336487 DOI: 10.1097/scs.0000000000009493] [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: 09/01/2022] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
The Le Fort I osteotomy is used to reposition the maxilla to correct numerous maxillofacial and occlusal deformities. The aim of this study was to delineate perioperative complication rates associated with Le Fort I osteotomy and determine whether the number of maxillary segments or bone grafting yielded increased complication rates. Patients undergoing Le Fort I osteotomy from 2012 to 2019 were identified from the multi-institution "National Surgical Quality Improvement Program" database using Current Procedure Terminology codes. The predictor variables of interest included maxillary segmentation defined as 1, 2, or 2 pieces and the presence or absence of bone graft. Perioperative complications were collected as the primary outcome variable, including superficial and deep space infections, wound dehiscence, airway complication, peripheral nerve injury, and hemorrhage. The secondary outcome variables included readmission and reoperation rate within the 30-day postoperative period. Complication rates were compared using multivariate analysis across groups stratified by the number of maxillary segments and inclusion of bone grafting. Of the 532 patients that met the inclusion criteria, 333 (63%) underwent 1-piece, 114 (21%) 2-piece, and 85 (16%) 2-piece Le Fort I osteotomy procedures. A total of 48 patients exhibited complications (9%), with hemorrhage (2.3%) being the most common complication observed. The number of maxillary segments was not a significant predictor of perioperative complications ( P = 0.948) nor was the use of bone grafting ( P = 0.279).
Collapse
Affiliation(s)
- Mia M Joseph
- School of Dentistry, University of California at Los Angeles
| | - Nirbhay S Jain
- Division of Plastic Surgery, Department of Surgery, University of California at Los Angeles
| | - Michael R DeLong
- Division of Plastic Surgery, Department of Surgery, University of California at Los Angeles
| | - Wayne Ozaki
- Division of Oral and Maxillofacial Surgery, School of Dentistry and Section of Craniofacial Surgery, Division of Plastic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, CA
| |
Collapse
|
8
|
Camps-Perepérez I, Guijarro-Martínez R, da Rosa BM, Haas OL, Hernández-Alfaro F. Three-dimensional dentoskeletal changes following minimally invasive surgically assisted rapid palatal expansion: a prospective study. Int J Oral Maxillofac Surg 2023; 52:460-467. [PMID: 35909027 DOI: 10.1016/j.ijom.2022.07.004] [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: 11/01/2021] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm2 at the palate level and 23.3 mm2 at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed.
Collapse
Affiliation(s)
| | - R Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain; Institute of Maxillofacial Surgery and Implantology, Teknon Medical Centre, Barcelona, Spain, Universitat Internacional de Catalunya, Barcelona, Spain
| | - B M da Rosa
- Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - O L Haas
- Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery and Implantology, Teknon Medical Centre, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, and Program in Orthognathic Surgery, Universitat Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
9
|
Bohner L, Lustosa RM, Stamm T, Hanisch M, Kleinheinz J, Jung S. Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study. Odontology 2023; 111:201-206. [PMID: 35737145 PMCID: PMC9810686 DOI: 10.1007/s10266-022-00721-9] [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] [Received: 03/03/2022] [Accepted: 05/30/2022] [Indexed: 01/12/2023]
Abstract
The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T0), one month (T1), and 6 months (T2) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T0 to T1 (p = 0.003), followed by an increase from T1 to T2 (p = 0.040). PPD (T0 = 1.72 ± 0.46; T2 = 2.13 ± 0.43) and CAL (T0 = 1.24 ± 0.55; T2 = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T0, T1 and T2. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.
Collapse
Affiliation(s)
- Lauren Bohner
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Rômulo Maciel Lustosa
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany ,Department of Periodontology, State University of Maringá, Maringá, A. Colombo 5790, 87020-900 Brazil
| | - Thomas Stamm
- Department of Orthodontics, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| | - Susanne Jung
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1 Gebäude W30, 48149 Muenster, Germany
| |
Collapse
|