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Can Yücel H, Kozanoğlu E, Edim Akalin B, Onur Sütçü A, Şentürk E, Emekli U. The Effects of the Maxillary Movements in Angle Class 2 and 3 Malocclusion Treatment on Nose Air Flow Amount, Rate, and Resistance. J Craniofac Surg 2024:00001665-990000000-01577. [PMID: 38743044 DOI: 10.1097/scs.0000000000010305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Maxillary movements performed during orthognathic surgery affect the external and internal anatomy of the nose. The functional and anatomical effects may change nasal airway parameters after the surgery, and these alterations can be examined objectively by rhinomanometry. In this study, patients who underwent maxillary orthognathic surgery were divided into 3 groups based on their surgical plans: advancement (group 1), impaction and advancement (group 2), and setdown and advancement (group 3). Preoperative and postoperative rhinomanometric data including the average nasal volume, minimum cross-sectional area, average airflow resistance of the right and left nasal passageways, and an average of both nasal passages were collected. The study included 50 patients who underwent orthognathic surgery between October 2021 and October 2022. There were 20 patients each in group 1 and group 2 and 10 patients in group 3. The average nasal passage volume increased in the advancement (group 1) and impaction-advancement (group 2) groups. In addition, the advancement (group 1) group had a decreased average airflow resistance. Setdown-advancement (group 3) group did not show a positive or negative effect on nasal airway parameters. Maxillary movements during orthognathic surgery revealed no adverse effect on nasal parameters. Moreover, advancement and impaction positively affected nasal functional and anatomical parameters.
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Affiliation(s)
- Hüseyin Can Yücel
- Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University
| | - Erol Kozanoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University
| | - Bora Edim Akalin
- Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University
| | - Ahmet Onur Sütçü
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erol Şentürk
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Emekli
- Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University
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Giotakis AI, Verius M, Steinbichler TB, Runge A, Kolk A, Hupp LC. Rhinoresistometry as a Cost-Efficient and Time-Saving Alternative to Acoustic Rhinometry for Longitudinal Assessment of Nasal Patency in Orthognathic Surgery. J Craniofac Surg 2024:00001665-990000000-01293. [PMID: 38260959 DOI: 10.1097/scs.0000000000009931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 01/24/2024] Open
Abstract
Rhinoresistometry (RRM) is implemented along with active anterior rhinomanometry (AAR) and can evaluate nasal dimensions [hydraulic diameter (HD)]. As acoustic rhinometry (AR) is time-consuming, the authors investigated if RRM can be an efficient alternative to AR in nasal dimension assessment in orthognathic surgery. In patients undergoing maxillary advancement and impaction (cases) and removal of maxillary cysts (controls), the authors evaluated RRM and AR, before and 1 year after surgery. Furthermore, the authors investigated the correlation of HD with Nasal Obstruction Symptom Evaluation score and volume by computed tomography and AAR. Lastly, the authors measured RMM reproducibility by the Bland-Altman agreement method in controls. In 14 cases, AR and RMM revealed a significant increase on both sides (all P < 0.011) and the right side, respectively (P = 0.028). The authors noted no changes in 14 controls. Hydraulic diameter correlated only with AAR (most P < 0.004). Acoustic rhinometry lasted ~4 minutes before or after decongestion. In controls, HD after surgery was as large (1.05 times larger) as before surgery (up to 39% error rates). Rhinoresistometry can reproducibly assess nasal dimension changes in orthognathic surgery in a way that is different from AR and correlates with nasal function. Rhinoresistometry can help clinicians avoid AR and save significant time, as well as financial and human resources.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Annette Runge
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Asan CY, Baydan E, Amuk M, Demirbaş AE. Does Le Fort I Osteotomy Influence Nasal Septum Deviation? J Oral Maxillofac Surg 2023; 81:1244-1251. [PMID: 37507103 DOI: 10.1016/j.joms.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Le Fort I osteotomy is a technique for surgically correcting the maxillary position. Le Fort I osteotomy may affect the nasolabial structures since a very close relationship exists between the maxilla and the nose. PURPOSE This study aimed to investigate the effect of different maxillary movements on the nasal septum after Le Fort I osteotomies with cone beam computed tomography (CBCT) images. We hypothesized that nasal septal angle changes after maxillary impaction and advancement movements. STUDY DESIGN, SETTING, AND SAMPLE This retrospective cohort study involved patients who underwent Le Fort I osteotomy to correct the maxillary position at Erciyes University, Oral and Maxillofacial Surgery Hospital. This study included patients who had CBCT images before (T0) and ≥12 months after (T1) surgery. Patients with a history of septoplasty or rhinoplasty before orthognathic surgery, congenital deformities, or posttraumatic deformities were excluded. PREDICTOR VARIABLES Its predictor variable was the direction and magnitude of the maxilla's vertical and horizontal movements. MAIN OUTCOME VARIABLE Change in septal deviation (in degrees) was the main outcome of the study. COVARIATES Age, sex, operation (Le Fort I alone or double jaw surgery), cartilage reduction, and anterior nasal spine reduction during surgery were covariates. DATA ANALYSIS Angle values were compared with independent samples t test or the Mann-Whitney U test in two-category variables. The Kruskal Wallis test was used to compare the angle values according to the movement. A P value of < .05 was considered statistically significant. RESULTS This study evaluated 154 CBCT images of 77 patients (44 [57.1%] females and 33 [42.9%] males), of which 68 (88.3%) had double jaw surgery and nine (11.7%) had single Le Fort I surgery. The average nasal septum angle was significantly smaller preoperatively (166.2° [157.1° to 172.15°]) than postoperatively (168.7° [131.5° to 180.0°]) across subjects (P = .031). The septal angle decreased in 28 patients, and the rate of postoperative angular change was higher in patients with both advancement and impaction during the surgery (P = .014). CONCLUSION AND RELEVANCE Septum deviation can occur in 37% of cases after Le Fort I surgery. Therefore, Le Fort osteotomies are associated with changes in nasal appearance.
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Affiliation(s)
- Canay Yılmaz Asan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
| | - Ebru Baydan
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Mehmet Amuk
- Specialist of Oral and Maxillofacial Radiology, Private Dental Clinic, Samsun, Turkey
| | - Ahmet Emin Demirbaş
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Hupp LC, Verius M, Kolk A, Steinbichler TB, Heppt H, Giotakis AI. The long-term effect of maxillary advancement and impaction on subjective and objective nasal patency: A retrospective case-control study. J Craniomaxillofac Surg 2023:S1010-5182(23)00081-1. [PMID: 37355368 DOI: 10.1016/j.jcms.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to investigate the change of nasal patency after maxillary advancement and impaction (MAXADV + IMP) in subjects with skeletal class III malocclusion (cases) and after removal of maxillary cysts in close proximity to the nasal floor in subjects that served as controls. NOSE score, volume derived by computed tomography (VOL), and acoustic rhinometry and rhinomanometry were retrospectively evaluated, before and one year after surgery. The movement of specific landmarks was also measured. NOSE score did not change after surgery, neither in 17 cases (p = 0.10) nor in 17 controls (p = 0.14). In cases, VOLpostop (10088 ± 4200 mm3) was significantly higher than VOLpreop (7807 ± 3721 mm3; p = 0.036). Maxillary advancement and inferior displacement of the ventral maxilla were noted by the movement of incisive foramen in the coronal (3.9 ± 5.4; p = 0.011) and Frankfurt Horizontal plane (2.2 ± 2.0; p = 0.001), respectively. In controls, VOLpostop (9749 ± 3654 mm3) was also significantly higher than VOLpreop (8473 ± 2624 mm3; p = 0.050). Cross-sectional areas, nasal flow and nasal resistance changed significantly after surgery in cases (6/30 pairs; p < 0.018), but not in controls (all p > 0.066). MAXADV + IMP increased nasal patency, but did not change the feeling of nasal breathing. Physicians should proceed with caution when informing patients about improvement of nasal breathing after MAXADV + IMP.
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Affiliation(s)
- Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Abdelwahab M, Huang A, Chou C, Fleury T, Riley R, Most S, Liu S. Patient's Perception of Nasal Function and Cosmesis After Maxillomandibular Advancement for Obstructive Sleep Apnea. Facial Plast Surg Aesthet Med 2023; 25:132-140. [PMID: 36048540 DOI: 10.1089/fpsam.2021.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Maxillomandibular advancement (MMA) remains one of the most effective surgeries for the treatment of obstructive sleep apnea (OSA), but it can be difficult to manage nasal and midfacial esthetics for patients requiring significant maxillary advancement. Objective: To evaluate changes in the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) after the modified MMA approach. Methods: This prospective study was conducted on subjects undergoing MMA at a tertiary referral center from September 2020 to August 2021. Nasal function, cosmesis, and sleepiness were assessed perioperatively with the SCHNOS, visual analog scale for nasal function and cosmesis, and Epworth sleepiness scale (ESS). Objective polysomnography data were also investigated. Results: Thirty-one subjects met inclusion criteria. After MMA, SCHNOS-O (obstruction domain) improved from 44.38 ± 26.21 to 19.03 ± -4.75 (p < 0.001). The SCHNOS-C (cosmesis domain) improved significantly from 13.95 ± 19.32 to 5.27 ± 8.93 (p = 0.029). Specific items evaluating self-esteem, nasal straightness, and symmetry showed significant improvement (p = 0.006, 0.025, 0.044). The ESS also improved from 9.41 ± 6.11 to 3.26 ± 3.03 (p < 0.001), and it correlated with nasal obstruction scores. Conclusion: In this study, patients' perception of nasal obstruction and appearance improved after applying the nasal modifications to MMA described for OSA.
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Affiliation(s)
- Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allen Huang
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Courtney Chou
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomaz Fleury
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Robert Riley
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Nasal Airway Function After Prophylactic Intranasal Surgery for Excessive Maxillary Superior Repositioning: A Retrospective Cohort Study Using the Nasal Obstruction Symptom Evaluation Scale. J Craniofac Surg 2023; 34:343-349. [PMID: 36044300 DOI: 10.1097/scs.0000000000008969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/25/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The purpose of this study is to evaluate the degree of nasal airway function after simultaneous intranasal corrective surgery and bimaxillary surgery in patients with excessive superior maxillary repositioning. MATERIALS AND METHODS A retrospective cohort study was conducted on consecutive LeFort I superior repositioning patients who also underwent simultaneous intranasal surgery to prevent airway obstruction between 2015 and 2019. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to all participants before the operation and after 1 year. RESULTS Fifteen patients (n=12 females; n=3 males) among 440 bimaxillary orthognathic surgery patients were enrolled with inclusion criteria of maxillary impaction between 8 and 12 mm. All subjects underwent at least LeFort I osteotomy, septoplasty, bilateral inferior turbinectomy, and bilateral sagittal split osteotomy. Two patients received custom-made total joint prosthesis. The primary outcome variable investigated was nasal function. The mean preop Nasal Obstruction Symptom Evaluation score was 24.33 and the mean postop score was 5. CONCLUSIONS Intranasal procedures performed simultaneously with 8 mm or more maxillary impaction improves postoperative functional outcome in terms of nasal airway patency and breathing. Partial inferior turbinectomies and septoplasty should be performed consistently to avoid nasal obstruction if the impaction of upper jaw exceeds 8 mm.
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Alagoz E, Unver T, Seker ED, Kurt G, Senturk E, Ozdem A, Dolanmaz D. EVALUATING CHANGES IN NASAL AIRWAY VOLUME AND NASAL AIRFLOW AFTER SURGICALLY ASSISTED RAPID MAXILLARY EXPANSION. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:533-542. [DOI: 10.1016/j.oooo.2022.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/10/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
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Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale. Arch Plast Surg 2021; 48:61-68. [PMID: 33503746 PMCID: PMC7861989 DOI: 10.5999/aps.2020.01431] [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: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale. METHODS This cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test. RESULTS Patients ranged in age from 18 to 29 years (mean±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores. CONCLUSIONS Nasal airway function as evaluated using the NOSE scale improved after maxillary impaction.
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Mirmohamadsadeghi H, Zanganeh R, Barati B, Tabrizi R. Does maxillary superior repositioning affect nasal airway function? Br J Oral Maxillofac Surg 2020; 58:807-811. [PMID: 32376038 DOI: 10.1016/j.bjoms.2020.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to assess nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity in patients who have had maxillary superior repositioning (MSR). This is a cross-sectional study, and nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity were evaluated by rhinometry and acoustic rhinometry techniques in patients who had had MSR. Thirty-two patients were studied, and the mean (SD) MSR was 5.03 (1.61) (range 3-8) mm. There was a significant correlation between the mean MSR and the mean change in nasal airflow and nasal resistance (p=0.001 and p=0.005, respectively). There was also a correlation between MSR and the change in the cross-sectional area of the inferior concha (p=0.001), but there was no correlation between the mean MSR and the change in cross-sectional area of the isthmus (p=0.07). Nasal airflow increases when the mean MSR is less than 6.5mm, and when maxillary impaction is 6.5mm or more, nasal airflow decreases. It seems, therefore, that MSR of less than 6.5mm was associated with an improvement in nasal airflow. When maxillary impaction was more than 6.5mm, nasal airflow and the cross-sectional area of the nasal cavity decreased, and nasal resistance increased.
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Affiliation(s)
| | - R Zanganeh
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Barati
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Tabrizi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Procacci P, Lanaro L, Trevisiol L, Bertossi D, Zotti F, Fabio L, D'Agostino A. Is post orthognathic maxillary sinusitis related to sino-nasal anatomical alterations? J Craniomaxillofac Surg 2019; 47:876-882. [DOI: 10.1016/j.jcms.2019.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges. METHODS Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z-scores. RESULTS Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies (p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia (p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry (p = 0.014). Repeated procedures used more 3-dimensional planning (p < 0.001), required all three osteotomies (p = 0.034), had longer operative times (p = 0.078), and all required hardware removal (p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up. CONCLUSIONS Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Khamashta-Ledezma L, Naini FB, Manisali M. Review of nasal changes with maxillary orthognathic surgery. J Istanb Univ Fac Dent 2017; 51:S52-S61. [PMID: 29354309 PMCID: PMC5750828 DOI: 10.17096/jiufd.09789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/19/2017] [Indexed: 11/15/2022] Open
Abstract
This article reviews the literature on nasal changes with maxillary orthognathic surgery. Understanding such changes is vital for surgical planning and for obtaining appropriate informed consent, and there are medico-legal implications. During orthognathic surgical planning a prediction of the effects of the different surgical movements is possible and this forms part of the basis of the planning stage. The predicted changes need to be identified and their desirability or not for each individual patient determined. Some techniques for managing undesirable nasal changes are discussed, including adjunct measures to minimize these potential effects (e.g. cinch sutures), and additional surgical procedures to manage the undesired nasal changes once they are produced.
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Affiliation(s)
| | - Farhad B Naini
- Consultant Orthodontist, St George's NHS Foundation Trust, London United Kingdom
| | - Mehmet Manisali
- Consultant Maxillofacial Surgeon, St George's NHS Foundation Trust, London United Kingdom
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Stability and surgical complications in segmental Le Fort I osteotomy: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1071-1087. [DOI: 10.1016/j.ijom.2017.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022]
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Kita S, Oshima M, Shimazaki K, Iwai T, Omura S, Ono T. Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture. J Oral Maxillofac Surg 2016; 74:2241-2251. [PMID: 27425883 DOI: 10.1016/j.joms.2016.06.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to evaluate the influence of maxillary impaction orthognathic surgery on nasal respiratory function and the efficacy of bone trimming at the inferior edge of the pyriform aperture. MATERIALS AND METHODS The participants were 10 patients (3 male and 7 female patients) with mandibular prognathism who underwent bimaxillary orthognathic surgery with maxillary impaction. The surgical procedures performed were Le Fort I osteotomy with bone trimming at the inferior edge of the pyriform aperture and bilateral sagittal split osteotomy. Three-dimensional models of the nasal cavity were reconstructed from preoperative and postoperative computed tomography images. Furthermore, we remodeled the nasal valve region based on the postoperative models by adding a 1-mm and 2-mm stenosis to investigate the effects of bone trimming at the inferior edge of the pyriform aperture on the pressure effort. The 3-dimensional models were simulated with computational fluid dynamics, and the results of the pressure effort and the cross-sectional area (CSA) were compared for the anterior, middle, and posterior parts of the nasal cavity. The Wilcoxon signed rank test and Spearman rank correlation coefficients were used for statistical comparisons (P < .05). RESULTS In the preoperative and postoperative models, there were considerable correlations between the CSA and the pressure effort in each part of the nasal cavity. The postoperative pressure effort showed a tendency to decrease and the CSA showed a tendency to increase in each part of the nasal cavity. In four 2-mm stenosis models, the pressure effort in the anterior nasal cavity was larger than the preoperative pressure effort and the CSA of the anterior nasal cavity was smaller than the preoperative CSA. CONCLUSIONS Bone trimming at the inferior edge of the pyriform aperture appears to be useful for avoiding nasal respiratory complications with maxillary impaction.
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Affiliation(s)
- Soma Kita
- Postgraduate Student, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Marie Oshima
- Professor, Institute of Industrial Science, The University of Tokyo, Komaba, Meguro-ku, Tokyo, Japan
| | - Kazuo Shimazaki
- Assistant Professor, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Toshinori Iwai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Susumu Omura
- Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Medical Center, Urafunecho, Minami-ku, Yokohama, Kanagawa, Japan
| | - Takashi Ono
- Professor, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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Correction of Symptomatic Chronic Nasal Airway Obstruction in Conjunction With Bimaxillary Orthognathic Surgery: Does It Complicate Recovery and Is It Effective? J Oral Maxillofac Surg 2015; 74:620.e1-11. [PMID: 26657162 DOI: 10.1016/j.joms.2015.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to assess the safety and efficacy of intranasal procedures carried out simultaneously with bimaxillary orthognathic surgery. MATERIALS AND METHODS The authors executed a retrospective cohort study derived from patients treated by a single surgeon at 1 institution from 2004 through 2013 with a minimum follow-up of 1 year (range, 1 to 10 yr). An index study group consisting of a consecutive series of patients with symptomatic chronic obstructive nasal breathing (CONB) and a bimaxillary developmental dentofacial deformity (DFD) also involving the chin were identified. They underwent a minimum of: Le Fort I osteotomy, bilateral sagittal ramus osteotomies, septoplasty, inferior turbinate reduction (ITR), and osseous genioplasty. Study variables included age at operation, gender, pattern of presenting DFD, presence of obstructive sleep apnea, segmentation of the maxilla, and airway management. The primary outcome variable studied was residual CONB. RESULTS During the study period, 262 patients met the inclusion criteria. Their age at operation averaged 25 years (range, 13 to 63 yr) and 134 were female (51%). The major patterns of presenting DFD included long face (29%) and maxillary deficiency (25%). No patients required nasal packing, reintubation, tracheostomy, or blood transfusion. In 6 of the 262 patients (2%), the intranasal procedures did not resolve nasal breathing difficulties. In these patients, procedures recommended included synechiae release (n = 3), revision septoplasty (n = 3), and further ITR (n = 4). An association between age at time of surgery and non-segmental Le Fort I osteotomy with the occurrence of residual nasal obstruction was confirmed. CONCLUSIONS When completing septoplasty and ITR through a Le Fort I, airway management need not be altered from standard protocol. The management of CONB in conjunction with orthognathic surgery is highly effective, with few complications. Non-segmental Le Fort I in patients at least 40 years of age is more likely to be associated with residual CONB, but the incidence remains low.
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Nocini PF, D'Agostino A, Trevisiol L, Favero V, Pessina M, Procacci P. Is Le Fort I Osteotomy Associated With Maxillary Sinusitis? J Oral Maxillofac Surg 2015; 74:400.e1-400.e12. [PMID: 26546843 DOI: 10.1016/j.joms.2015.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/30/2015] [Accepted: 10/07/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the association between Le Fort I osteotomy and the anatomic, radiologic, and symptomatic modifications of the maxillary sinus. MATERIALS AND METHODS Subjects who had undergone Le Fort I osteotomy from January 2008 to December 2013 were enrolled in a retrospective cohort study. The eligibility criteria were the availability of a cone beam computed tomography (CBCT) scan taken before and 12 to 24 months after the procedure. The exclusion criteria were the unavailability of CBCT scans, the use of tobacco, and previous orthognathic procedures. The primary predictor variable was time (pre-vs postoperative). The primary outcome variables were the sinus volume, mucosal thickening, iatrogenic alterations in the sinus anatomy, and rhinosinusitis symptoms, evaluated using the Sino-Nasal Outcome 20-item Test (SNOT-20). Descriptive statistics were computed for each variable, and paired analyses were used to compare the pre- and postoperative values. RESULTS The data from 64 subjects (mean age 27; 59.4% were female; median follow-up 32.4 months, range 13 to 66 months) were studied. Postoperatively, 1.6% of the sample (0% preoperatively) had moderate-to-severe and 15.6% (3.1% preoperatively) had mild-to-moderate sinusitis symptoms. The rest of the sample presented with mild to no symptoms. The increase in the SNOT scores after surgery was statistically significant (P = .016). Radiologic evidence of postoperative inflammatory processes affecting the paranasal sinuses was found in 27.3% of the sinuses (9.4% preoperatively). The postoperative Lund-Mackay scores were significantly greater (P = .0005). A 19% decrease was found in the mean postoperative sinus volume, with a 37% incidence of iatrogenic injury. CONCLUSIONS The study results indicate that Le Fort I osteotomies can have an important impact on sinus health. The postoperative radiologic evidence of maxillary sinus inflammatory processes and the incidence of rhinosinusitis symptoms and iatrogenic damage in these patients have led us to conclude that CBCT scans and the SNOT-20 questionnaire should be used routinely during postoperative monitoring. Larger long-term studies are warranted to clarify the postoperative outcomes and complications.
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Affiliation(s)
- Pier Francesco Nocini
- Professor and Chief, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Antonio D'Agostino
- Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Lorenzo Trevisiol
- Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
| | - Vittorio Favero
- Maxillo-Facial Surgeon, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Mattia Pessina
- Maxillo-Facial Surgeon, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Pasquale Procacci
- Assistant Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
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Menegat F, Monnazzi MS, Silva BN, de Moraes M, Gabrielli MAC, Pereira-Filho VA. Assessment of nasal obstruction symptoms using the NOSE scale after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2015; 44:1346-50. [PMID: 26187045 DOI: 10.1016/j.ijom.2015.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 06/18/2015] [Accepted: 06/25/2015] [Indexed: 11/24/2022]
Abstract
The Nasal Obstruction Symptom Evaluation (NOSE) scale is a reliable and valid instrument used widely in otorhinolaryngology to evaluate nasal obstruction symptoms in patients with nasal disorders. The purpose of this study was to assess nasal obstruction symptoms prospectively in patients undergoing surgically assisted rapid maxillary expansion (SARME) using the NOSE scale. Sixteen patients were studied (mean age 31±7.7 years), 10 women and six men, all with a transverse maxillary deficiency and an indication for SARME. Hyrax type devices were placed preoperatively and SARME was performed using Kraut's technique. The NOSE scale was applied prospectively to assess nasal obstruction symptoms. The results were recorded for each score on a scale ranging from 0 to 4, and these scores were multiplied by 5, generating a balanced scale from 0 to 100. Data were stratified according to NOSE scores, and nasal obstruction was categorized as mild (0-25), moderate (26-50), or severe (>50). The questionnaire was administered twice, first preoperatively and then at 6 months after surgery, and the results compared. Data were analyzed statistically using SAS statistical package software and showed that patients experienced a subjective improvement or did not have a worsening of nasal obstruction symptoms after SARME.
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Affiliation(s)
- F Menegat
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M S Monnazzi
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil.
| | - B N Silva
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M de Moraes
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M A C Gabrielli
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil
| | - V A Pereira-Filho
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil
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Prado DGDA, Nary Filho H, Berretin-Felix G, Brasolotto AG. Características respiratórias de indivíduos com deformidade dentofacial. REVISTA CEFAC 2014. [DOI: 10.1590/1982-021620148113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo compreender as características respiratórias em indivíduos com deformidades dentofaciais e verificar se há diferenças comparativamente a indivíduos com equilíbrio dentofacial. Métodos participaram 60 indivíduos (18 a 40 anos), 30 portadores de deformidade dentofacial e 30 de um grupo controle. Foi realizada avaliação do Tempo Maximo de Fonação das emissões /a/, /i/, /u/, /s/, /z/ e contagem de números pelo programa Sound Forge (Sony); avaliação da capacidade vital e coordenação pneumofonoarticulatória, pelo espirômetro PonyFx. Os resultados foram comparados pelo teste “t” de Student. Resultados os indivíduos com deformidade dentofacial apresentaram valores de Tempo Maximo de Fonação inferiores aos indivíduos com equilíbrio dentofacial nas emissões: “s” para aqueles com má oclusão esquelética classe II e homens; “z” para indivíduos com má oclusão classe II; contagem de números para os homens. As medidas extraídas pela espirometria foram semelhantes entre os indivíduos com e sem deformidade dentofacial. Conclusão não houve diferenças em relação à capacidade vital e coordenação pneumofonoarticulatória, mas o grupo com deformidade dentofacial apresentou valores reduzidos de Tempo Maximo de Fonação em emissões que contêm fonemas consonantais.
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