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Ma B, Rojas EM, Li AYZ, Kinard BE. To what extent is oral and maxillofacial surgery educational content posted on Instagram? Int J Oral Maxillofac Surg 2024; 53:887-893. [PMID: 39079767 DOI: 10.1016/j.ijom.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024]
Abstract
Hashtags on Instagram help users globally search for posts to their liking. This study aimed to determine who posts the most popular oral and maxillofacial surgery (OMS) hashtags on Instagram and to evaluate the impact of educational content. The posts were analyzed for the type of post and differences between content creators when posting OMS-related content. This cross-sectional study evaluated OMS content categorized by 36 hashtags. The top 9 posts with each hashtag were evaluated based on the type of content creator, if it was a video or picture, and if it was educational or for marketing purposes. 6 million posts existed among 36 hashtags. Regarding the categories of person/organization posting the content (US or non-US oral and maxillofacial surgeon, residency program, patient, and 'other'), the top posts (N = 295) were posted by 'other' and the least by 'residency program'. Among the posts by non-US oral and maxillofacial surgeons, there was 3.8-fold more marketing content, while among the posts by US oral and maxillofacial surgeons, there was 2-fold more educational content. Educational posts achieved the highest engagement in terms of 'likes'. This study highlights how oral and maxillofacial surgeons can educate the general population and expand their reach.
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Affiliation(s)
- B Ma
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E M Rojas
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A Y Z Li
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - B E Kinard
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Chen PRF, Chuang KT, Hsu SSP, Chen YR, Chen CT. Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1142e-1151e. [PMID: 37257138 DOI: 10.1097/prs.0000000000010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry. METHODS This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups. RESULTS Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients ( P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients ( P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment. CONCLUSION The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Kai-Ti Chuang
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital
| | | | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chien-Tzung Chen
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital at Linkou
- Craniofacial Research Center at Taoyuan, Chang Gung University, College of Medicine
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Ettinger RE, Hopper RA, Susarla SM. Discussion: Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1152e-1154e. [PMID: 38810161 DOI: 10.1097/prs.0000000000011015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Russell E Ettinger
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
| | - Richard A Hopper
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
| | - Srinivas M Susarla
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
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Montenegro de Andrade ÉJ, Toledo Teixeira da Silveira I, Marinho Barcellos B, Reis de Araújo Carvalho L, Faria Yaedú RY. Fracture patterns in cleft orthognathic surgery. a cross-sectional study. REVISTA CIENTÍFICA ODONTOLÓGICA 2024; 12:e194. [PMID: 39119124 PMCID: PMC11304855 DOI: 10.21142/2523-2754-1202-2024-194] [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: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 08/10/2024] Open
Abstract
Objective This study aims to identify fracture patterns on the lingual aspect of the mandible following Bilateral Sagittal Osteotomy of the Mandibular Ramus and correlate these patterns with mandibular anatomical characteristics in patients with cleft lip and palate. Methods Two hundred cone beam CT scans were analyzed, with 100 scans in the preoperative period to assess mandibular anatomy and 100 in the postoperative period to evaluate the course of fractures on the lingual surface after surgery. Results Statistical analysis revealed no correlation between the depth of the mandibular fossa and the type of fracture after bilateral sagittal osteotomy. Similarly, there was no association between the height and angle of the mandibular body and the type of fracture. The most common fracture type observed was the type 3 pattern, characterized by a line running through the mandibular canal. Furthermore, no relationship was identified between the studied anatomical aspects and the occurrence of undesired fractures. Conclusions The anatomical data presented in this study can assist surgeons in selecting the safest surgical techniques and optimal osteotomy sites, particularly in patients with cleft lip and palate.
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Affiliation(s)
- Ércio Júnior Montenegro de Andrade
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
| | - Isabela Toledo Teixeira da Silveira
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
| | - Bhárbara Marinho Barcellos
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
| | - Luciano Reis de Araújo Carvalho
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
| | - Renato Yassutaka Faria Yaedú
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
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Dastgir R, Bemudez PF, Valiathan M, Baur DA, Quereshy FA. The use of clear aligners in orthognathic surgeries: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e22-e40. [PMID: 38160198 DOI: 10.1016/j.oooo.2023.07.016] [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: 05/25/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 01/03/2024]
Abstract
Pre- and postoperative fixed orthodontic appliances are the customary and standard practice for patients with treatment planned for undergoing orthognathic surgery. Traditionally, most patients undergoing orthognathic surgeries are in their late teens. Although these patients still compose the greatest pool of the orthognathic surgery population, many patients seek orthognathic surgery later in life. This older patient population often has different concerns and goals than the younger patient population. One of these concerns is often the aesthetic appearance of fixed appliances and the time required to wear these appliances pre- and postoperatively. Today, removable orthodontic appliances consisting of a series of clear aligners have gained immense popularity due to their aesthetic appeal over traditional braces. Additional benefits of removable orthodontic appliances include improved oral hygiene leading to a decreased risk of gingivitis. Whereas clear aligner systems are commonly used in the nonsurgical orthodontic population, there has been limited use of Invisalign in the orthognathic surgery population. In this article, we present a case series of 5 patients who successfully underwent orthognathic surgery using clear aligners for pre- and postoperative orthodontic treatment.
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Affiliation(s)
- Ramtin Dastgir
- Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Paul F Bemudez
- Faculty, Ascension Macomb-Oakland Hospital-Warren Campus, Detroit, MI, USA
| | - Manish Valiathan
- Professor and Director, Department of Orthodontics, Case Western Reserve University, Cleveland, OH, USA
| | - Dale A Baur
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Faisal A Quereshy
- Professor and Program Director, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA.
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Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F. Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing. Oral Maxillofac Surg 2024; 28:345-353. [PMID: 36959345 DOI: 10.1007/s10006-023-01148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars. MATERIAL AND METHODS A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique. RESULTS A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020). CONCLUSION The results obtained support concomitant molar extraction with BSSO as a feasible option.
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Affiliation(s)
- Adaia Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain.
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - Özlem Kesmez
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - David Neagu-Vladut
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
| | - Federico Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Hattori Y, Huang PC, Chang CS, Chen YR, Lo LJ. Facial Palsy after Orthognathic Surgery: Incidence, Causative Mechanism, Management, and Outcome. Plast Reconstr Surg 2024; 153:697-705. [PMID: 37104501 DOI: 10.1097/prs.0000000000010597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be underreported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome. METHODS A retrospective review of orthognathic surgery records between January of 1981 and May of 2022 was conducted in the authors' craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiologic images, and photographs were collected. RESULTS A total of 20,953 sagittal split ramus osteotomies (SSROs) were performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, the Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than the Hunsuck technique using the manual twist splitting ( P < 0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median duration of 3 months [interquartile range (IQR), 2.75 to 6 months] after surgery, whereas 11.1% attained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster median recovery (3 months; IQR, 2 to 3 months) than the complete palsy patients (6 months; IQR, 4 to 6.25 months) ( P = 0.02). CONCLUSIONS The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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Affiliation(s)
- Yoshitsugu Hattori
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Po-Cheng Huang
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
| | - Chun-Shin Chang
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Yu-Ray Chen
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
| | - Lun-Jou Lo
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
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Straub A, Gubik S, Kübler A, Breitenbuecher N, Vollmer A, Renner T, Müller-Richter U, Hartmann S, Brands R. Comparison of Patient-Specific Condylar Positioning Devices and Manual Methods in Orthognathic Surgery: A Prospective Randomized Trial. J Clin Med 2024; 13:737. [PMID: 38337431 PMCID: PMC10856595 DOI: 10.3390/jcm13030737] [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: 12/28/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND This study investigated whether patient-specific condylar positioning devices (CPDs) are beneficial compared to the conventional manual positioning of the condyles. METHODS In this prospective, randomized trial, patients undergoing orthognathic surgery with a bilateral sagittal split osteotomy of the mandible were included. The ascending ramus was positioned with computer-aided designed and computer-aided manufactured (CAD/CAM) patient-specific devices in the CPD group and manually in the control group. Postoperatively, cone-beam computed tomography (CBCT) was performed to align the virtually planned position with the postoperative result. RESULTS Thirty patients were enrolled in the study, with 14 randomized to the CPD group and 16 to the control group. In the CPD group, the ascending ramus differed in the postoperative CBCT scan from the virtually planned position by 0.8 mm in the left/right, 0.8 mm in the front/back, and 1.3 mm in the cranial/caudal direction. The corresponding control-group values were 1.1 mm, 1.3 mm, and 1.6 mm. CPD and controls differed significantly for the left/right movement of the rami (p = 0.04) but not for the other directions or rotations (p > 0.05). CONCLUSIONS The results demonstrate that both methods are accurate, and postoperative results matched the virtually planned position precisely. It can be assumed that the described CPDs are beneficial when a condylar position different from the preoperative is desired.
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Affiliation(s)
- Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
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Al-Dawoody AD, Hamad SA, Kheder Khrwatany KA, Saleem TH. Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy? Head Face Med 2023; 19:49. [PMID: 37936216 PMCID: PMC10629200 DOI: 10.1186/s13005-023-00396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
AIM The purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies. PATIENTS AND METHODS The sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern. RESULTS In the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p < 0.05). CONCLUSION Inferior border osteotomy tends to direct the lingual split fracture line toward the lower and posterior borders of the mandible and minimizes bad splits; however, further studies are needed to confirm our findings.
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Ho JPTF, Zhou N, van Riet TCT, Schreurs R, Becking AG, de Lange J. Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis. J Pers Med 2023; 13:1517. [PMID: 37888128 PMCID: PMC10608325 DOI: 10.3390/jpm13101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7°, p = 0.006 and 4.7°, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p > 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.
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Affiliation(s)
- Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Tom C. T. van Riet
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
| | - Alfred G. Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.Z.); (T.C.T.v.R.); (R.S.); (J.d.L.)
- Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
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Udayakumar SIV, Kim D, Choi SY, Kwon TG. 3D simulation of interosseous interference in sagittal split ramus osteotomy for mandibular asymmetry. Maxillofac Plast Reconstr Surg 2023; 45:32. [PMID: 37718330 PMCID: PMC10505600 DOI: 10.1186/s40902-023-00400-x] [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: 06/17/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the pattern of predicted interosseous interference and to determine the influencing factor to volume of bony interference using a computer-assisted simulation system. This retrospective study recruited 116 patients with mandibular prognathism who had undergone sagittal split ramus osteotomy (SSRO) with or without maxillary osteotomy. The patients were divided into 3 groups according to the amount of menton (Me) deviation: less than 2 mm (Group 1), 2-4 mm (Group 2), and more than 4 mm (Group 3). Changes in the distal segments following BSSRO and the volume of the interosseous interference between the proximal and distal segments were simulated after matching preoperative occlusion and postoperative expected occlusion with the cone-beam computed tomography data. Ramal inclinations and other skeletal measurements were analyzed before surgery, immediately after surgery, and at least 6 months after surgery. RESULTS The anticipated interosseous interference was more frequently noted on the contralateral side of chin deviation (long side) than the deviated site (short side) in Groups 2 and 3. More interference volume was predicted at the long side (186 ± 343.9 mm3) rather than the short side (54.4 ± 124.4 mm3) in Group 3 (p = 0.033). The bilateral difference in the volume of the interosseous interference of the osteotomized mandible was significantly correlated with the Me deviation (r = - 0.257, p = 0.009) and bilateral ramal inclination (r = 0.361, p < 0.001). The predictor variable that affected the volume of the osseous interference at each side was the amount of Me deviation (p = 0.010). CONCLUSION By using the 3D simulation system, the potential site of bony collision could be visualized and successfully reduced intraoperatively. Since the osseous interference can be existed on any side, unilaterally or bilaterally, 3D surgical simulation is necessary before surgery to predict the osseous interference and improve the ramal inclination.
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Affiliation(s)
- Santhiya Iswarya Vinothini Udayakumar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940, Republic of Korea
| | - Dohyoung Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940, Republic of Korea
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940, Republic of Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940, Republic of Korea.
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Byun SH, Park SY, Yi SM, Park IY, On SW, Jeong CK, Kim JC, Yang BE. Clinical Stability of Bespoke Snowman Plates for Fixation following Sagittal Split Ramus Osteotomy of the Mandible. Bioengineering (Basel) 2023; 10:914. [PMID: 37627799 PMCID: PMC10452001 DOI: 10.3390/bioengineering10080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Maxillofacial skeletal surgery often involves the use of patient-specific implants. However, errors in obtaining patient data and designing and manufacturing patient-specific plates and guides can occur even with accurate virtual surgery. To address these errors, bespoke Snowman plates were designed to allow movement of the mandible. This study aimed to compare the stability of bespoke four-hole miniplates with that of a bespoke Snowman plate for bilateral sagittal split ramus osteotomy (SSRO), and to present a method to investigate joint cavity changes, as well as superimpose virtual and actual surgical images of the mandible. This retrospective study included 22 patients who met the inclusion criteria and underwent orthognathic surgery at a university hospital between 2015 and 2018. Two groups were formed on the basis of the plates used: a control group with four-hole bespoke plates and a study group with bespoke Snowman plates. Stability was assessed by measuring the condyle-fossa space and superimposing three-dimensional virtual surgery images on postoperative cone-beam computed tomography (CBCT) scans. No significant differences were observed in the condyle-fossa space preoperatively and 1 year postoperatively between the control and study groups. Superimposing virtual surgery and CBCT scans revealed minimal differences in the landmark points, with no variation between groups or timepoints. The use of bespoke Snowman plates for stabilizing the mandible following SSRO exhibited clinical stability and reliability similar to those with bespoke four-hole plates. Additionally, a novel method was introduced to evaluate skeletal stability by separately analyzing the condyle-fossa gap changes and assessing the mandibular position.
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Affiliation(s)
- Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Min Yi
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Chun-Ki Jeong
- Department of Dental Science & Technology, Shingu College, Seongnam 13174, Republic of Korea;
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
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Blum FMS, Möhlhenrich SC, Raith S, Pankert T, Peters F, Wolf M, Hölzle F, Modabber A. Evaluation of an artificial intelligence-based algorithm for automated localization of craniofacial landmarks. Clin Oral Investig 2023; 27:2255-2265. [PMID: 37014502 PMCID: PMC10159965 DOI: 10.1007/s00784-023-04978-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Due to advancing digitalisation, it is of interest to develop standardised and reproducible fully automated analysis methods of cranial structures in order to reduce the workload in diagnosis and treatment planning and to generate objectifiable data. The aim of this study was to train and evaluate an algorithm based on deep learning methods for fully automated detection of craniofacial landmarks in cone-beam computed tomography (CBCT) in terms of accuracy, speed, and reproducibility. MATERIALS AND METHODS A total of 931 CBCTs were used to train the algorithm. To test the algorithm, 35 landmarks were located manually by three experts and automatically by the algorithm in 114 CBCTs. The time and distance between the measured values and the ground truth previously determined by an orthodontist were analyzed. Intraindividual variations in manual localization of landmarks were determined using 50 CBCTs analyzed twice. RESULTS The results showed no statistically significant difference between the two measurement methods. Overall, with a mean error of 2.73 mm, the AI was 2.12% better and 95% faster than the experts. In the area of bilateral cranial structures, the AI was able to achieve better results than the experts on average. CONCLUSION The achieved accuracy of automatic landmark detection was in a clinically acceptable range, is comparable in precision to manual landmark determination, and requires less time. CLINICAL RELEVANCE Further enlargement of the database and continued development and optimization of the algorithm may lead to ubiquitous fully automated localization and analysis of CBCT datasets in future routine clinical practice.
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Affiliation(s)
| | | | - Stefan Raith
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Tobias Pankert
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Florian Peters
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Michael Wolf
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
| | - Frank Hölzle
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Ali Modabber
- Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
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Fujii Y, Hatori A, Horiuchi M, Sugiyama-Tamura T, Hamada H, Sugisaki R, Kanno Y, Sato M, Kono M, Hasegawa O, Kawase-Koga Y, Chikazu D. Computed tomography evaluation of risk factors for an undesirable buccal split during sagittal split ramus osteotomy. PLoS One 2023; 18:e0279850. [PMID: 36862692 PMCID: PMC9980734 DOI: 10.1371/journal.pone.0279850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/15/2022] [Indexed: 03/03/2023] Open
Abstract
Sagittal split ramus osteotomy (SSRO) sometimes induces an irregular split pattern referred to as a bad split. We investigated the risk factors for bad splits in the buccal plate of the ramus during SSRO. Ramus morphology and bad splits in the buccal plate of the ramus were assessed using preoperative and postoperative computed tomography images. Of the 53 rami analyzed, 45 had a successful split, and 8 had a bad split in the buccal plate. Horizontal images at the height of the mandibular foramen showed that there were significant differences in the ratio of the forward thickness to the backward thickness of the ramus between patients with a successful split and those with a bad split. In addition, the distal region of the cortical bone tended to be thicker and the curve of the lateral region of the cortical bone tended to be smaller in the bad split group than in the good split group. These results indicated that a ramus shape in which the width becomes thinner towards the back frequently induces bad splits in the buccal plate of the ramus during SSRO, and more attention should be paid to patients who have rami of these shapes in future surgeries.
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Affiliation(s)
- Yasuyuki Fujii
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
- * E-mail:
| | - Ayano Hatori
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Miwa Horiuchi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomoko Sugiyama-Tamura
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hayato Hamada
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Risa Sugisaki
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuki Kanno
- Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Marika Sato
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Michihide Kono
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - On Hasegawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoko Kawase-Koga
- Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Lee SF, Chen YA, Lin CH, Wen-Ching Ko E. Surgical Stability After Proximal Segment Angle Alteration in Patients with Class III Facial Asymmetry. J Oral Maxillofac Surg 2023:S0278-2391(23)00252-5. [PMID: 37011882 DOI: 10.1016/j.joms.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE Patients with facial asymmetry often seek improved symmetry in lower face contour resulting in transverse movement of the proximal segments. The study aimed to investigate the association between transverse change in the proximal segments and postoperative relapse after the surgical correction of skeletal Class III facial asymmetry. METHODS The retrospective cohort study included consecutive patients with skeletal Class III asymmetry who underwent 2-jaw orthognathic surgery. The primary predictor variable was ramus plane angle (RPA). The patients were grouped as small (S group, <4°) and large (L group, ≥4°) changes in RPA. The primary outcome was the positional change of B point, menton, and the intergonial width. Cone-beam computed tomography images were obtained before surgery (T0), 1 week after surgery (T1), and debond (T2). Intergroup comparison was conducted with independent t test. Correlations between the variables were estimated by Pearson correlation. RESULTS The study sample was composed of 60 subjects with 30 subjects in each study group. In the S group, the mean surgical changes of RPA were inward rotated 0.91° bilaterally. In the L group, the mean surgical changes of RPA were inward rotated 4.80° and 0.32° on the deviated and non-deviated side. After surgery, further minor inward adaptation of both sides was noted (<1 mm), and intergonial distance reduced with these changes in the proximal segments. By comparing the postsurgical stability between S and L group, the overall sagittal and vertical stability had no significant difference between 2 groups. However, the postsurgical transverse menton relapse (ΔMe in T2-T1) was significantly larger in L group (0.81 ± 1.40 mm) than S group (0.04 ± 1.32 mm) by 0.77 mm (P = .014). CONCLUSION Greater surgical changes in the proximal segments had minor clinical effect on transverse stability. Minor transvers overcorrection of 1 mm is recommended in cases with severe facial symmetry with extensive changes in the proximal segments.
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Affiliation(s)
- Syu-Fang Lee
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Ying-An Chen
- Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Associate Professor, Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hui Lin
- Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Associate Professor, Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Associate Professor, Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea. J Clin Med 2023; 12:jcm12020503. [PMID: 36675432 PMCID: PMC9863088 DOI: 10.3390/jcm12020503] [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: 11/24/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Maxillomandibular advancement (MMA) has been shown to be the most effective surgical therapy for obstructive sleep apnea (OSA). Despite high success rates, there are patients who are considered as non-responders to MMA. In order to triage and inform these patients on their expected prognosis of MMA before the surgery, this study aimed to develop, internally validate, and calibrate a prediction model for the presence of surgical success for MMA in patients with OSA. Methods: A retrospective cohort study was conducted that included patients that had undergone MMA for moderate to severe OSA. Baseline clinical, polysomnographic, cephalometric, and drug-induced sleep endoscopy findings were recorded as potential predictors. Presence or absence of surgical success was recorded as outcome. Binary logistic regression analyses were conducted to develop the model. Performance and clinical values of the model were analyzed. Results: One hundred patients were included, of which sixty-seven (67%) patients reached surgical success. Anterior lower face height (ALFH) (OR: 0.93 [0.87−1.00], p = 0.05), superior posterior airway space (SPAS) (OR: 0.76 [0.62−0.92], p < 0.05), age (OR: 0.96 [0.91−1.01], p = 0.13), and a central apnea index (CAI) <5 events/hour sleep (OR: 0.16 [0.03−0.91], p < 0.05) were significant independent predictors in the model (significance level set at p = 0.20). The model showed acceptable discrimination with a shrunken area under the curve of 0.74, and acceptable calibration. The added predictive values for ruling in and out of surgical success were 0.21 and 0.32, respectively. Conclusions: Lower age at surgery, CAI < 5 events/hour, lower ALFH, and smaller SPAS were significant predictors for the surgical success of MMA. The discrimination, calibration, and clinical added values of the model were acceptable.
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Eshghpour M, Samieirad S, Shooshtari Z, Shams A, Ghadirimoghaddam N. Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A Comparative Study using Three-dimensional Finite Elements Analysis. World J Plast Surg 2023; 12:43-57. [PMID: 37220573 PMCID: PMC10200092 DOI: 10.52547/wjps.12.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
Background The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques. Methods This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded. Results The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings. Conclusion Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.
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Affiliation(s)
- Majid Eshghpour
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Abdolrahim Shams
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Ghadirimoghaddam
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Reliability of 3D Stereophotogrammetry for Measuring Postoperative Facial Swelling. J Clin Med 2022; 11:jcm11237137. [PMID: 36498711 PMCID: PMC9736147 DOI: 10.3390/jcm11237137] [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: 11/01/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to determine the reliability of three-dimensional (3D) stereophotogrammetry as a measurement instrument for evaluating soft tissue changes in the head and neck area. Twelve patients received a bilateral sagittal split osteotomy (BSSO). Test and retest 3D photographs were captured within the first three postoperative weeks, and a reference 3D photograph was capture at three months postoperatively. Distance measurements, mean and root mean square of the distance map, and volume differences were obtained. Reliability of these parameters was assessed by intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and smallest detectable change (SDC). All distance measurements had an ICC > 0.91, and the distance map parameters and volume differences showed ICCs > 0.89. The neck region presented the largest SEMs (5.09 mL) and SDC (14.1 mL) for the volume difference. In conclusion, 3D stereophotogrammetry is reliable for distance and volume measurements of soft tissues in patients after a BSSO advancement.
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Imampai S, Patchanee S, Klaisiri A, Chaiprakit N. Evaluation of Skeletal Changes after Mandibular Setback Surgery Using the NM-Low Z Plasty Technique in Skeletal Class III Patients. Eur J Dent 2022. [PMID: 35785823 DOI: 10.1055/s-0042-1749364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Bilateral sagittal split osteotomy (BSSO) is a standard mandibular setback procedure for skeletal class III patients. Our center has been using NM-Low Z plasty, a BSSO modification, since 2016. The study's objective was to evaluate skeletal changes in 38 skeletal class III patients following mandibular setback surgery using NM-Low Z plasty. With Dolphin Imaging software, three lateral cephalograms were traced and digitized: T0, T1, and T2. The distance between the B-point and the SN7 perpendicular line defined immediate changes after surgery (T1-T0) and stability after surgery (T2-T1). The reliability test included 6 cephalograms retraced after 2-week interval. At point B, the principal result was horizontal movement forward. STATISTICAL ANALYSIS The analysis used paired t-tests. RESULTS The mean mandibular setback was 9.78 mm, and the mean skeletal relapse was 2.61 mm, or 26.69%. Statistical analysis showed postoperative differences (p < 0.05). Vertical measurement in B-SN7 reduced immediately and postoperatively. CONCLUSION Postoperatively, the mandible relapsed significantly forward and upward. Rotational relapse is a concern with NM-Low Z plasty in hypo-/: normodivergent patients.
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Affiliation(s)
- Sarunpong Imampai
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Bangkok, Thailand
| | - Siripatra Patchanee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Bangkok, Thailand.,Thammasat University Research Unit in Mineralized Tissue Reconstruction, Thammasat University, Bangkok, Thailand
| | - Awiruth Klaisiri
- Division of Restorative Dentistry, Faculty of Dentistry, Thammasat University, Bangkok, Thailand.,Thammasat University Research Unit in Restorative and Esthetic Dentistry, Thammasat University, Bangkok, Thailand
| | - Narissaporn Chaiprakit
- Thammasat University Research Unit in Mineralized Tissue Reconstruction, Thammasat University, Bangkok, Thailand.,Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Bangkok, Thailand
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Yazar L, Aydil BA, Ayhan M, Çömlekçioğlu Y. Comparison of standard miniplates and locked miniplates in post-traumatic fracture stabilization. ULUS TRAVMA ACIL CER 2022; 28:715-722. [PMID: 35652876 PMCID: PMC10443005 DOI: 10.14744/tjtes.2022.59447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bicortical screws (lag and positional) or miniplates with monocortical screws are generally used for the rigid fixa-tion of the sagittal split ramus osteotomy (SSRO) in maxillofacial surgery. However, in this osteosynthesis method, the plate must be perfectly adapted to the bone to prevent misalignment of the bone segment and occlusal changes. In addition, it is necessary to prevent the position of the condyle in the mandibular fossa from changing after fixation. In recent years, locked miniplate systems have been used to overcome these complications. METHODS The aim of this study is to compare the commonly used 2.0 mm standard miniplate/screw systems and 2.0 mm locking miniplate/screw systems in fresh sheep jaws with Obwegeser-Dal Pont (OD) and Hunsuck-Epker (HE) modifications, by evaluating standard parameters. RESULTS Our study consists of two main groups and two subgroups. 40 sheep hemimandibulae were randomly divided into two main groups. Each group was randomly divided into two subgroups. There are ten hemimandibulae (n=10) in each subgroup. Linear force test was applied using 4-hole standard miniplate and 4-hole locking miniplate systems on sheep jaws with 5 mm advancement by applying OD and HE techniques, which are two frequently preferred modifications in SSRO. For statistical analysis SPSS® 16.0 (Sta-tistical Package for the Social Sciences, SPSS Inc. Chicago, Illinois, USA) package program was used. It was statistically compared with the 95% confidence interval using the Pearson coefficient, and p<0.05 was interpreted as significant. The values of the loading forces applied to the samples in the groups were subjected to analysis of variance (ANOVA) to confirm the normality of the sample. Multiple comparisons were made between groups using the Tukey test. The mean loadings in the groups were analyzed by one-way ANOVA. CONCLUSION In general, as the strength of the force increases, the displacement values increase in all groups, but although it was observed that the locked miniplate/screw system was more stable than the standard miniplate/screw system, no statistically significant difference was found.
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Affiliation(s)
- Lütfiye Yazar
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Barış Altuğ Aydil
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Mustafa Ayhan
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Yağmur Çömlekçioğlu
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
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Dumrongwanich O, Chantarapanich N, Patchanee S, Inglam S, Chaiprakit N. Finite element analysis between Hunsuck/Epker and novel modification of Low Z plasty technique of mandibular sagittal split osteotomy. Proc Inst Mech Eng H 2022; 236:646-655. [DOI: 10.1177/09544119221082436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck–Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.
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Affiliation(s)
- Orawee Dumrongwanich
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
| | - Siripatra Patchanee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Samroeng Inglam
- Division of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Narissaporn Chaiprakit
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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22
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Kajita T, Nogami S, Suzuki H, Saito S, Yamauchi K, Takahashi T. Radiologic risk factors for persistent mandibular nerve neurosensory disturbance following sagittal split osteotomy. J Oral Maxillofac Surg 2022; 80:1183-1190. [DOI: 10.1016/j.joms.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Zhang H, He Y, Chen Y, Liu J, Jin Q, Xu S, Fu X, Qiao J, Yu B, Niu F. Virtual Reality and Three-Dimensional Printed Models Improve the Morphological Understanding in Learning Mandibular Sagittal Split Ramus Osteotomy: A Randomized Controlled Study. Front Surg 2022; 8:705532. [PMID: 35004831 PMCID: PMC8727369 DOI: 10.3389/fsurg.2021.705532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/01/2021] [Indexed: 01/17/2023] Open
Abstract
Background: The mandibular sagittal split ramus osteotomy (SSRO) is a routine operation performed to correct mandibular deformity including mandibular retrusion, protrusion, deficiency, and asymmetry. The SSRO remains a challenging procedure for junior surgeons due to a lack of adequate morphological knowledge necessary for success in clinical practice. Virtual reality (VR) and three-dimensional printed (3DP) models have been widely applied in anatomy education. The present randomized, controlled study was performed to evaluate the effect of traditional educational instruments, VR models, and 3DP models on junior surgeons learning the morphological information required to perform SSRO. Methods: Eighty-one participants were randomly assigned to three learning groups: Control, VR, and 3DP. Objective and subjective tests were used to evaluate the learning effectiveness of each learning instrument. In the objective test, participants were asked to identify 10 anatomical landmarks on normal and deformed models, draw the osteotomy line, and determine the description of SSRO. In the subjective test, participants were asked to provide feedback regarding their subjective feelings about the learning instrument used in their group. Results: The objective test results showed that the VR and 3DP groups achieved better accuracy in drawing the osteotomy line (p = 0.027) and determining the description of SSRO (p = 0.023) than the Control group. However, there was no significant difference among the three groups regarding the identification of anatomical landmarks. The VR and 3DP groups gave satisfactory subjective feedback about the usefulness in learning, good presentation, and enjoyment. The Control and 3DP groups reported positive feelings about ease of use. Conclusion: The current findings suggest that VR and 3DP models were effective instruments that assisted in the morphological understanding of SSRO-related anatomical structures. Furthermore, 3DP models may be a promising supplementary instrument to bridge the gap between conventional learning and clinical practice.
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Affiliation(s)
- Henglei Zhang
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu He
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Chen
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianfeng Liu
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qi Jin
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shixing Xu
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xi Fu
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia Qiao
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bing Yu
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng Niu
- Department of Craniomaxillofacila Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Mashkina AA, Chkadua TZ, Ermolin VI, Isaichikova OV, Romanovsky MA. [Condylar displacement following orthognathic surgery]. STOMATOLOGIIA 2022; 101:77-84. [PMID: 36268926 DOI: 10.17116/stomat202210105177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The overview of the current literature in the research of mandibular condyle displacement after orthognathic surgeries was done. The correct postoperative mandibular condyle position is considered as one of the determinants of the stability of treatment results.
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Affiliation(s)
- A A Mashkina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - M A Romanovsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Zeynalzadeh F, Shooshtari Z, Eshghpour M, Hoseini Zarch SH, Tohidi E, Samieirad S. Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial. World J Plast Surg 2021; 10:25-33. [PMID: 34912664 PMCID: PMC8662680 DOI: 10.29252/wjps.10.3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to assess the incidence of bad split fractures during Bilateral Sagittal Split Osteotomy (BSSO) mandibular setback surgery using Dal Pont and Hunsuck techniques. METHODS All healthy adults with skeletal class III discrepancy, who were candidates for mandibular setback surgery were enrolled in this randomized clinical trial in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from 2018-2020. These patients were randomly divided into two equal groups; one group underwent BSSO using Dal Pont osteotomy while the Hunsuck osteotomy was employed for the other group. A bad split fracture which identified through intra-operative clinical and postoperative radiographic examination was the outcome variable. The significance level was set at 0.05 using SPSS 16. RESULTS Overall, 104 consecutive patients, comprising of 52 (50%) males with an average age of 23.09±3.08 were recruited. The average duration of osteotomy and splitting was reported to be 22.74±3.06 min. 10 bad split fractures (9.62%) were observed; 7 of which occurred in the Dal Pont group and 3 in the Hunsuck group. However, this difference was not significant. In 80% of the cases, bad split osteotomy occurred in the proximal segment, while this finding was identified in the distal segment in 20% of cases. The average duration of osteotomy and splitting was significantly longer in the Dal Pont group (P<0.001). CONCLUSION The duration of osteotomy and splitting is much shorter when the Hunsuck technique is employed, and the incidence of unfavorable fractures is also less compared to the Dal Pont osteotomy technique.
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Affiliation(s)
- Farhad Zeynalzadeh
- Oral and Maxillofacial Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Eshghpour
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seied Hosein Hoseini Zarch
- Oral and Maxillofacial Radiology, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Tohidi
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Classification and Clinical Treatments for Unfavorable Fractures of the Proximal Segment in Sagittal Spilt Ramus Osteotomy: A Retrospective Study of 964 Cases. J Craniofac Surg 2021; 33:1445-1449. [PMID: 34629384 DOI: 10.1097/scs.0000000000008276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Unfavorable fractures in sagittal split ramus osteotomy are hard to manage. The aim of this study is to develop a new classification method for unfavorable fractures of the proximal segment to guide clinical managements. After reviewing 964 cases of sagittal split ramus osteotomy, we found that the unfavorable fractures can be divided into 3 types: mandibular ramus transverse fractures (Type 1), bad fractures accompanied by free fragments (Type 2), and unexpected separation patterns without free fragments (Type 3). We calculated the incidence of each fracture type and provided instructions for their corresponding treatments. Thirty-six patients suffered from unfavorable fractures (7.4% of patients), among which 32 patients had unilateral fractures and 4 patients had bilateral fractures. There were 2 Type 1 fractures (0.2% of split sites), 8 Type 2 fractures (0.8% of split sites), and twenty-six Type 3 fractures (2.3% of split sites). Type 1 unfavorable fractures are difficult to deal with, but Types 2 and 3 are generally manageable and they have no significant impact on the final outcomes. The new classification can effectively guide treatment strategies for unfavorable fractures. Severe cases of unfavorable fractures are rare, and most unfavorable fracture cases have a positive prognosis if correctly treated in time.
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27
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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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Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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Harding J, Hartsfield JK, Mian AS, Allan BP, Naoum S, Lee RJH, Goonewardene MS. Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates. Int J Oral Maxillofac Surg 2021; 51:219-225. [PMID: 33941394 DOI: 10.1016/j.ijom.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine whether the use of custom osteosynthesis plates increased the accuracy of proximal segment position following bilateral sagittal split osteotomy in a cohort of 30 patients when compared to a control group of 25 patients who had surgery with conventional plates. Surgery was performed by a single surgeon between October 2015 and December 2017. Post-surgical cone beam computed tomography scans were segmented using Mimics Innovation Suite (Materialise NV), and surface-based superimposition was achieved using ProPlan CMF (Materialise NV). However, there was a tendency for the rotational error to be smaller in the custom group than in the control group. The root mean square error in both groups and for all variables fell within clinical parameters of 2 mm and 4°. In conclusion, the results of this study indicate that customized mandibular fixation plates do not necessarily improve the accuracy of the proximal segments post-surgically; however they may be of benefit in individual patients.
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Affiliation(s)
- J Harding
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - J K Hartsfield
- Orthodontics and Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA; Division of Oral Development and Behavioural Sciences, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - A S Mian
- School of Computer Science and Software Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - B P Allan
- Private Maxillofacial Surgery Practice, Perth, Australia
| | - S Naoum
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - R J H Lee
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - M S Goonewardene
- Orthodontic Department, UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia.
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30
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Loureiro RM, Collin J, Sumi DV, Araújo LC, Murakoshi RW, Gomes RLE, Daniel MM. Postoperative CT findings of orthognathic surgery and its complications: A guide for radiologists. J Neuroradiol 2021; 49:17-32. [PMID: 33864896 DOI: 10.1016/j.neurad.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.
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Affiliation(s)
- Rafael Maffei Loureiro
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - John Collin
- Bristol Royal Infirmary, Department of Oral and Maxillofacial Surgery, Marlborough Street, Bristol BS2 8HW, United Kingdom.
| | - Daniel Vaccaro Sumi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Luziany Carvalho Araújo
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Rodrigo Watanabe Murakoshi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Regina Lucia Elia Gomes
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Mauro Miguel Daniel
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
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31
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Jermwiwatkul W, Boonsiriseth K, Viwattanatipa N. Treacher Collins syndrome: Orthodontic treatment with mandibular distraction osteogenesis and orthognathic surgery. Am J Orthod Dentofacial Orthop 2021; 159:836-851. [PMID: 33840530 DOI: 10.1016/j.ajodo.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
Interdisciplinary treatment for patients with Treacher Collins syndrome is challenging because of the rarity of the condition and the wide variety of phenotypic expression. A 23-year-old male was diagnosed with Treacher Collins syndrome with a history of severe obstructive sleep apnea. He presented with a Pruzansky-Kaban classification grade I mandible, skeletal type II pattern with a hyperdivergent mandibular plane, severe convex profile, and Class II malocclusion with a missing mandibular incisor. Improvement of facial esthetics was achieved by a combination of orthodontics, mandibular distraction osteogenesis, and 2-jaw maxillomandibular advancement surgery. Presurgical orthodontic treatment involved permanent tooth extraction to relieve severe crowding, and Class III mechanics were employed to increase overjet. Correction of mandibular hypoplasia by increasing ramal height and the mandibular length was done by intraoral mandibular distraction osteogenesis. Counterclockwise rotation of the mandibular plane angle and a Class III occlusion with negative overjet were achieved after mandibular distraction osteogenesis. A postdistraction posterior open bite was maintained with a biteplane during the consolidation period. Subsequently, 2-jaw orthognathic surgery was performed. LeFort I osteotomy was done for maxillary advancement to correct an anterior crossbite, eliminate canting, and reestablish occlusal contact at the mandibular occlusal plane. Bilateral sagittal split ramus osteotomy was done to correct the residual mandibular deviation. A genioplasty was also performed to improve chin projection. Postoperatively, the oropharyngeal airway was enlarged. The patient's facial profile and obstructive sleep apnea problem were improved as a result of advancement and counterclockwise rotation of the maxillomandibular complex.
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Ueki K, Moroi A, Takayama A, Saito Y, Sato M, Baba N, Kimura Y, Fujimoto K, Koizumi M, Hotta A, Iguchi R, Yoshizawa K. Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:496-505. [PMID: 34274287 DOI: 10.1016/j.oooo.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to assess mandibular morphologic changes to the condyle, ramus, mandibular body, and inferior mandibular border defect after sagittal split ramus osteotomy in class II and III patients. STUDY DESIGN The relationships among the condyle, ramus, and mandibular body measured by computed tomography preoperatively and postoperatively were assessed and factors related to the reduction of the condylar square and mandibular inferior border defect were examined. RESULTS Patients included 72 female patients with jaw deformity (36 skeletal class II cases, 36 skeletal class III cases). Postoperative reduction of the condylar square was significantly correlated with preoperative condylar height in patients with class II (P = .0297) vs preoperative condylar height and preoperative mandibular height in patients with class III (P < .0001). A mandibular inferior border defect was found in 18 of 72 class II sides (25.0%) and was significantly related to the position of the osteotomy line and attachment side of the inferior border cortex (P < .0001). CONCLUSIONS This study's findings suggest that the postoperative reduction of the condyle could be associated with preoperative condylar height. However, the mandibular inferior border defect in class II advancement surgery could be independently associated with technical factors in sagittal split ramus osteotomy.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Yuki Saito
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Momoko Sato
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Nana Baba
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Yujiro Kimura
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Kana Fujimoto
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Mai Koizumi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Asami Hotta
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Ran Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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Van Camp P, Verstraete L, Van Loon B, Scheerlinck J, Nout E. Antibiotics in orthognathic surgery: a retrospective analysis and identification of risk factors for postoperative infection. Int J Oral Maxillofac Surg 2020; 50:643-648. [PMID: 33162297 DOI: 10.1016/j.ijom.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/03/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
This study was undertaken to evaluate the infection rate following orthognathic surgery and to identify possible risk factors. A retrospective study was conducted. Patients undergoing orthognathic surgery from August 1, 2017 to July 31, 2018 were included. The outcome variable was surgical site infection (SSI). All data were analysed with respect to demographics and procedure specifications. A total of 137 patients (mean age 28.5±12.69 years) were included in this study, of whom 20 (14.6%) developed a SSI. The only risk factor identified was the type of surgery: those undergoing mandibular osteotomies (in bilateral sagittal split osteotomy (BSSO) or bimaxillary osteotomies) were far more likely to develop infections. Third molar teeth were removed during orthognathic surgery in 28.5% of the procedures, and a genioplasty was performed in 10.9%. Removal of osteosynthesis material because of infectious reasons was necessary in 10.2% of patients, with a strong association to previous SSI. In conclusion, this study showed an infection rate of 14.6% with no link to any demographic risk factor. Neither the simultaneous removal of third molar teeth nor genioplasty was found to be a risk factor for SSI. For literature comparison purposes, there is a clear need for the international guidelines defining SSI to be used.
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Affiliation(s)
- P Van Camp
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweestedenhospital, Tilburg, The Netherlands.
| | - L Verstraete
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweestedenhospital, Tilburg, The Netherlands
| | - B Van Loon
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweestedenhospital, Tilburg, The Netherlands
| | - J Scheerlinck
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweestedenhospital, Tilburg, The Netherlands
| | - E Nout
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweestedenhospital, Tilburg, The Netherlands
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Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study. Plast Reconstr Surg 2020; 146:622-632. [PMID: 32459733 DOI: 10.1097/prs.0000000000007069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial allotransplantation including the temporomandibular joints may improve the functional outcomes in face transplant candidates who have lost or damaged this joint. METHODS Linear and angular measurements were taken in 100 dry skulls and mandibles and in 100 three-dimensionally-reconstructed facial computed tomographic scans to determine the variability of the temporomandibular joint, glenoid fossa, and mandible. A vascular study was performed in six fresh cadaveric heads, followed by harvest of the face allograft in three heads. Next, four heads were used for mock transplantation (two donors and two recipients). The full facial allograft included four different segments: a Le Fort III, a mandibular tooth-bearing, and two condyle and temporomandibular joint-bearing segments. Statistical analysis was performed using SAS software. RESULTS In only one-third of the skulls, the condylar shape was symmetric between right and left sides. There was a wide variability in the condylar coronal (range, 14.3 to 23.62 mm) and sagittal dimensions (range, 5.64 to 10.96 mm), medial intercondylar distance (range, 66.55 to 89.91 mm), and intercondylar angles (range, 85.27 to 166.94 degrees). This high variability persisted after stratification by sex, ethnicity, and age. The temporomandibular joint was harvested based on the branches of the superficial temporal and maxillary arteries. The design of the allograft allowed fixation of the two condyle and temporomandibular joint-bearing segments to the recipient skull base, preserving the articular disk-condyle-fossa relationship, and differences were adjusted at the bilateral sagittal split osteotomy sites. CONCLUSION Procurement and transplantation of a temporomandibular joint-containing total face allograft is technically feasible in a cadaveric model.
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Jiang N, Wang M, Bi R, Wu G, Zhu S, Liu Y. Risk factors for bad splits during sagittal split ramus osteotomy: a retrospective study of 964 cases. Br J Oral Maxillofac Surg 2020; 59:678-682. [PMID: 33952406 DOI: 10.1016/j.bjoms.2020.08.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023]
Abstract
To identify the potential risk factors for bad splits, we calculated the incidence of bad splits from 484 patients with 964 cases of sagittal split ramus osteotomy (SSRO) and investigated the association between the occurrence of bad splits and risk factors such as gender, patients' age, class of occlusion, unimaxillary or bimaxillary surgery, presence of the lower third molar, thickness of the ascending ramus, and the distance from the mandibular canal to the buccal cortical bone. The results showed that 40 sides (4.149%) with bad splits occurred in 36 patients (7.438%). The mean (SD) gap width from the canal to the buccal cortex for the bad split group, at 4.02 (1.20)mm, was narrower (p=0.003; OR=0.689; 95% CI=0.538 to 0.882) than the normal split group 4.80 (1.72)mm. On the contrary, no statistical significance (p>0.05) was detected between the patients with bad splits and those with normal splits for the other factors. In conclusion, SSRO patients with narrower distances from the mandibular canal to the buccal cortex were more prone to bad splits. More attention should be paid to patients with this risk factor during future surgeries.
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Affiliation(s)
- N Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - M Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - R Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - G Wu
- Department of Plastic and Aesthetic Surgery, Hospital of Stomatology, Jilin University, Changchun 130000, China.
| | - S Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Y Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Carlos HV, Marta BL, Orlando PM, Samuel UE, Sader R, Seifert LB. Stress distribution is susceptible to the angle of the osteotomy in the high oblique sagittal osteotomy (HOSO): biomechanical evaluation using finite element analyses. Comput Methods Biomech Biomed Engin 2020; 24:67-75. [PMID: 32845167 DOI: 10.1080/10255842.2020.1810242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM This computational study aimed to evaluate the influence of the angle of the osteotomy when performing a high oblique sagittal osteotomy over the distribution of stress to the osteosynthesis plates and mandibular segments. Material and methods: For this purpose, a finite element analysis of different combinations was carried out based on the osteotomy angle and mandibular mobilization using Autodesk Inventor® resulting in a total of 72 simulations. To check the correlation between the osteotomy angles with respect to the tension in the mandibular structure in different mobilizations, a student t-test was used. Results: The results of the advancement mobilizations (2.5 mm to 5.5 mm) reported increasing values for tension in the probe of the fourth screw and in the probe of the plate surface as the osteotomy angle increased (p-value <10-8). The results of the setback mobilizations (-2.5 mm to -5.5 mm) show comparable values (p-value <10-8). The resulting contact surface between bone segments varies depending on the osteotomy angle, increasing 44.67% from 45° to 70° and decreasing 22.05% when the angle is reduced to 30°. Conclusion: The angle of the osteotomy is a very relevant parameter in the design of the studied mandibular osteotomy, since the distribution of the reported stresses is substantially susceptible to its variation.
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Affiliation(s)
- Herrera-Vizcaíno Carlos
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Baselga Lahoz Marta
- Applied Mechanics and Bioengineering Group (AMB) of Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | | | - Udeabor E Samuel
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Robert Sader
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lukas Benedikt Seifert
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Susarla SM, Ettinger RE, Dodson TB. Is It Necessary to Free the Inferior Alveolar Nerve From the Proximal Segment in the Sagittal Split Osteotomy? J Oral Maxillofac Surg 2020; 78:1382-1388. [DOI: 10.1016/j.joms.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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38
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Suojanen J, Hodzic Z, Palotie T, Stoor P. CAD/CAM Engineered Patient-Specific Impants as a Reposition Device in Le Fort I and Modified Subcondylar Osteotomies: Case Report of Facial Deformity Correction in Acromegaly. Craniomaxillofac Trauma Reconstr 2020; 13:226-236. [PMID: 33456692 DOI: 10.1177/1943387520924521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acromegaly is a medical condition where elevated growth hormone or insulin-like growth factor I levels cause several changes in the craniofacial soft and hard features. We report the correction of facial deformity and posterior open bite with Le Fort I and modified subcondylar osteotomies in a patient affected by acromegaly. Computer-aided design and manufacturing generated saw and drill guides were used to perform osteotomies and segment removal. The placement of the patient-specific implants (PSIs) was guided by predesigned drill holes ensuring the required and planned movement of the jaws and position of the PSIs. After segment removal, the PSIs fitted the predesigned drill holes with high precision and were secured without problems. The planned amount of mandibular and maxillary movement was achieved. The occlusion and osteotomies remained stable for the follow-up of 22 months. The use of PSIs combined with guided surgery can be beneficial for selected cases with asymmetry or posterior open bite enabling new approaches and yielding good functional and aesthetic outcome. The modification of conventional ramus osteotomy combined with utilization of ramus segment removal and the use of PSI for reposition is an interesting and promising technique for rare conditions with ramus height asymmetry.
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Affiliation(s)
- Juho Suojanen
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Oral and Maxillo-Facial Surgery, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Zlatan Hodzic
- Departments of Oral and Maxillo-Facial Diseases at the University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Palotie
- Departments of Oral and Maxillo-Facial Diseases at the University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patricia Stoor
- Departments of Oral and Maxillo-Facial Diseases at the University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Rougier G, Boisson J, Thurieau N, Kogane N, Mangione F, Picard A, Dallard J, Cherfa L, Szmytka F, Kadlub N. Sagittal split ramus osteotomy-related biomechanical properties. Br J Oral Maxillofac Surg 2020; 58:975-980. [PMID: 32624266 DOI: 10.1016/j.bjoms.2020.05.002] [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: 11/04/2019] [Accepted: 05/02/2020] [Indexed: 10/23/2022]
Abstract
Sagittal split ramus osteotomy (SSRO) is one of the most common maxillofacial operations, and the technique relies on a directed fracture involving different biomechanical variables. The aim of this study was to find out the biomechanical characteristics involved during each step of sagittal split osteotomy. We sampled eight fully dentate human mandibles and used the right side for hardness tests and the left side for a traction-to-fracture test within an unfinished SSRO. Right sides were sampled in five parts underlying the corticotomy course and tested with a hardness testing automatic machine. The mean hardness measures ranked to 21.5HV (Hardness Vickers Unit): 17.8HV; 27.4HV; 22.7HV; 28.7HV; for the lingual, diagonal, vestibular, full ramus, and full body samples, respectively. Left sides were cut using Epker's technique, and split with an electromechanical testing machine. The higher values reached before fracture in the traction-to-fracture tests ranked to 99.1N/6.7mm; 137.2N/10.8mm; 36.2N/4.2mm; 93.0N/7.3mm; 74.0N/8.1mm; 78.1N/4.5mm; 90.9N/10.6mm; and 64.7N/4.1mm, respectively, for specimens I, II, III, IV, V, VI, VII and VIII. This study provides to our knowledge the first biomechanical characteristics of SSRO and proposes a reproducible method for evaluation.
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Affiliation(s)
- G Rougier
- Department of Maxillofacial Surgery and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France.
| | - J Boisson
- IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - N Thurieau
- IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - N Kogane
- Department of Maxillofacial Surgery and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - F Mangione
- EA 2496 Laboratory Orofacial Pathologies, Imagery and Biotherapies, Dental School and Life imaging Platform (PIV), University Paris Descartes Sorbonne Paris Cité, Montrouge, France
| | - A Picard
- Department of Maxillofacial Surgery and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; University of Paris, Paris, France
| | - J Dallard
- IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - L Cherfa
- IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - F Szmytka
- IMSIA, ENSTA Paris-Tech, Department of Mechanical Engineering, Palaiseau, France
| | - N Kadlub
- Department of Maxillofacial Surgery and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; University of Paris, Paris, France
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Hu J, Song Y, Wang D, Yuan H, Jiang H, Cheng J. Patterns of lingual split and lateral bone cut end and their associations with neurosensory disturbance after bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:595-601. [DOI: 10.1016/j.ijom.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
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Cordier G, Sigaux N, Ibrahim B, Cresseaux P. The intermediate length BSSO: Finding the balance between the classical and short designs. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:70-73. [PMID: 31479765 DOI: 10.1016/j.jormas.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/17/2022]
Abstract
Bilateral Sagittal Split Osteotomy (BSSO) is performed in orthognathic surgery to treat cases of dento-skeletal malformation. We present a shorter BSSO variant that allows for the realization of all orthognathic movements. This line respects the basilar rim and allows to modify the position of the mandibular angles. The splitting is more natural, separating the mandible into two anatomical subunits: the rising branch and the horizontal branch. This variant layout may also be associated with Chin Wing genioplasty.
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Affiliation(s)
- G Cordier
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, 165, chemin du grand Revoyet 69495 Pierre Benite cedex, France.
| | - N Sigaux
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, 165, chemin du grand Revoyet 69495 Pierre Benite cedex, France.
| | - B Ibrahim
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, 165, chemin du grand Revoyet 69495 Pierre Benite cedex, France.
| | - P Cresseaux
- Chirurgie Maxillo-Faciale, Hôpital Privé Jean Mermoz, 55, avenue Jean Mermoz, 69008 Lyon, France.
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42
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Verhelst PJ, Van der Cruyssen F, De Laat A, Jacobs R, Politis C. The Biomechanical Effect of the Sagittal Split Ramus Osteotomy on the Temporomandibular Joint: Current Perspectives on the Remodeling Spectrum. Front Physiol 2019; 10:1021. [PMID: 31447704 PMCID: PMC6692453 DOI: 10.3389/fphys.2019.01021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/24/2019] [Indexed: 01/18/2023] Open
Abstract
The sagittal split ramus osteotomy is a key approach for treating dentofacial deformities. Although it delivers excellent results, the sagittal split ramus osteotomy is believed to induce stress to the temporomandibular joint. Potential stress inducers could be classified as intra- and postoperative factors resulting in an inflammatory response and molecular cascades, which initiate physiological remodeling. Occasionally, this process exceeds its capacity and causes pathological remodeling, through either degenerative joint disease or condylar resorption. Hard evidence on how orthognathic surgery causes inflammation and how this inflammation is linked to the spectrum of remodeling remains scarce. Current concepts on this matter are mainly based on clinical observations and molecular mechanisms are extrapolated from fundamental research in other body parts or joints. This perspective study provides an overview of current knowledge on molecular pathways and biomechanical effects in temporomandibular joint remodeling. It provides research directions that could lead to acquiring fundamental evidence of the relation of orthognathic surgery and inflammation and its role in remodeling. Performing osteotomies in animal models and identifying inflammatory mediators as well as their effect on the joint seem promising. Patients affected by pathological remodeling can also provide samples for histological as well as molecular analysis. Individual susceptibility analysis by linking certain suspect phenotypes to genetic variation could identify the cause and molecular pathway responsible for degenerative joint disease and condylar resorption, ultimately leading to clinically applicable treatment and prevention strategies.
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Affiliation(s)
- Pieter-Jan Verhelst
- 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
| | - Fréderic Van der Cruyssen
- 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
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven, Leuven, Belgium.,Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - 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
| | - 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
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de Araujo Filho NP, Rios TL, Jose da Silva E, Iafelice dos Santos T, Fernandes da Silva AL, Borba AM. Orthognathic Surgery Combined with Glossectomy and Mandibular Constriction: A Case Report. Open Dent J 2019. [DOI: 10.2174/1874210601913010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Conventional orthognathic surgery can become challenging when multiple goals such as correction of transverse and anteroposterior discrepancies of the dental arches are aimed. Thus, additional procedures such as midline mandible osteotomy for mandibular constriction and tongue reduction due to true macroglossia may be alternatives to a more functional and aesthetical outcome.
Case Report:
A treatment of a 35-year-old female patient with Class III sagittal skeletal pattern marked by an increased angle facial profile, maxillary retrusion, vertical maxillary deficiency, and mandibular protrusion, a Class III malocclusion associated to an edentulous maxilla, partially dentate mandible, transverse mandibular excess and true macroglossia. With an Index of Orthognathic Functional Treatment Need (IOFTN) grade 5, the patient underwent bimaxillary orthognathic surgery, mandible constriction and partial glossectomy. After about a year of follow-up, the patient demonstrated skeletal stability for the orthognathic procedures as well preservation of tongue function.
Conclusion:
The combination of the techniques performed was effective in the treatment of the multifaceted deformities, providing satisfactory function, harmonious facial aspect and enabling effective prosthetic rehabilitation to the patient.
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44
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Impact of Le-Fort I osteotomy on anatomical and functional aspects of the nasal airway and on quality of life. Eur Arch Otorhinolaryngol 2019; 276:1065-1073. [PMID: 30643961 DOI: 10.1007/s00405-018-05277-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Orthognathic surgery is a well-established procedure for skeletal deformities. Beneficial influences to the posterior airway space (PAS) have been described, but little is known about the subjective aesthetical and functional nasal aspects after orthognathic surgery. The aim of this study was to evaluate nasal airflow by anterior rhinomanometry and volumetric changes in the nasal airway space after mono- or bimaxillary surgery using cone-beam computed tomography (CBCT) and a new segmentation software. Furthermore, changes of patient's quality of life (QoL) should be assessed. METHODS Ten patients (9 skeletal class malformation III, 1 skeletal class malformation I) were included. CBCT images, rhinological inspections and anterior rhinomanometries were performed before (T0) and after surgery (T1). All patients completed the FROI-17, the ROE and the SF-36 questionnaires. RESULTS A significant postoperative gain for nasal airway volume compared with the baseline was shown (p < 0.014). No statistically significant differences between pre- and postoperative flow rates were found (p = 0.114). Pre- and postoperative cohorts did not differ in responses of disease-specific (ROE and FROI-17) and generic QoL questionnaires (SF-36). CONCLUSION Maxillary relocation surgery leads to a significant increase in nasal airway space. Subjectively, orthognathic patients did not experience any functional but psychosocial aspects after bimaxillary surgery.
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45
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Vieira Santos ZTB, Goulart DR, Sigua-Rodriguez EA, Pozzer L, Olate S, Albergaria-Barbosa JR. Mechanical evaluation of the use of conventional and locking miniplate/screw systems used in sagittal split ramus osteotomy. J Korean Assoc Oral Maxillofac Surg 2017; 43:77-82. [PMID: 28462190 PMCID: PMC5410431 DOI: 10.5125/jkaoms.2017.43.2.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/06/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022] Open
Abstract
Objectives The aim of this study was to compare the mechanical resistance of four different osteosyntheses modeled in two different sagittal split ramus osteotomy (SSRO) designs and to determine the linear loading in a universal testing machine. Materials and Methods An in vitro experiment was conducted with 40 polyurethane hemimandibles. The samples were divided into two groups based on osteotomy design; Group I, right angles between osteotomies and Group II, no right angles between osteotomies. In each group, the hemimandibles were distributed into four subgroups according to the osteosynthesis method, using one 4-hole 2.0 mm conventional or locking plate, with or without one bicortical screw with a length of 12.0 mm (hybrid technique). Each subgroup contained five samples and was subjected to a linear loading test in a universal testing machine. Results The peak load and peak displacement were compared for statistical significance using PASW Statistics 18.0 (IBM Co., USA). In general, there was no difference between the peak load and peak displacement related to osteotomy design. However, when the subgroups were compared, the osteotomy without right angles offered higher mechanical resistance when one conventional or locking 2.0 mm plate was used. One locking plate with one bicortical screw showed higher mechanical resistance (162.72±42.55 N), and these results were statistically significantly compared to one conventional plate with monocortical screws (P=0.016) and one locking plate with monocortical screws (P=0.012). The difference in peak displacement was not statistically significant based on osteotomy design or internal fixation system configuration. Conclusion The placement of one bicortical screw in the distal region promoted better stabilization of SSRO. The osteotomy design did not influence the mechanical behavior of SSRO when the hybrid technique was applied.
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Affiliation(s)
| | - Douglas Rangel Goulart
- Division of Oral and Maxillofacial Surgery, State University of Campinas, Campinas, Brazil
| | | | - Leandro Pozzer
- Division of Oral and Maxillofacial Surgery, State University of Campinas, Campinas, Brazil
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco, Chile.,Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
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Möhlhenrich SC, Kniha K, Peters F, Ayoub N, Goloborodko E, Hölzle F, Fritz U, Modabber A. Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications. J Craniomaxillofac Surg 2017; 45:762-767. [DOI: 10.1016/j.jcms.2017.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/05/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022] Open
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47
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Agbaje JO, Gemels B, Salem AS, Anumendem D, Vrielinck L, Politis C. Modified Mandibular Inferior Border Sagittal Split Osteotomy Reduces Postoperative Risk for Developing Inferior Border Defects. J Oral Maxillofac Surg 2016; 74:1062.e1-9. [DOI: 10.1016/j.joms.2016.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 12/15/2022]
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Steenen SA, van Wijk AJ, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg 2016; 45:971-9. [PMID: 26980136 DOI: 10.1016/j.ijom.2016.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 11/26/2022]
Abstract
An unfavourable and unanticipated pattern of the bilateral sagittal split osteotomy (BSSO) is generally referred to as a 'bad split'. Patient factors predictive of a bad split reported in the literature are controversial. Suggested risk factors are reviewed in this article. A systematic review was undertaken, yielding a total of 30 studies published between 1971 and 2015 reporting the incidence of bad split and patient age, and/or surgical technique employed, and/or the presence of third molars. These included 22 retrospective cohort studies, six prospective cohort studies, one matched-pair analysis, and one case series. Spearman's rank correlation showed a statistically significant but weak correlation between increasing average age and increasing occurrence of bad splits in 18 studies (ρ=0.229; P<0.01). No comparative studies were found that assessed the incidence of bad split among the different splitting techniques. A meta-analysis pooling the effect sizes of seven cohort studies showed no significant difference in the incidence of bad split between cohorts of patients with third molars present and concomitantly removed during surgery, and patients in whom third molars were removed at least 6 months preoperatively (odds ratio 1.16, 95% confidence interval 0.73-1.85, Z=0.64, P=0.52). In summary, there is no robust evidence to date to show that any risk factor influences the incidence of bad split.
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Affiliation(s)
- S A Steenen
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands.
| | - A J van Wijk
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry (ACTA) in Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Spaarne Gasthuis Haarlem, Academic Medical Centre (AMC), Amsterdam, and Academic Centre for Dentistry (ACTA) in Amsterdam, The Netherlands
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49
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Steenen SA, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. Int J Oral Maxillofac Surg 2016; 45:887-97. [PMID: 26936377 DOI: 10.1016/j.ijom.2016.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/03/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022]
Abstract
An unfavourable and unanticipated pattern of the mandibular sagittal split osteotomy is generally referred to as a 'bad split'. Few restorative techniques to manage the situation have been described. In this article, a classification of reported bad split pattern types is proposed and appropriate salvage procedures to manage the different types of undesired fracture are presented. A systematic review was undertaken, yielding a total of 33 studies published between 1971 and 2015. These reported a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies in 10,271 patients. The total reported incidence of bad split was 2.3% of sagittal splits. The most frequently encountered were buccal plate fractures of the proximal segment (types 1A-F) and lingual fractures of the distal segment (types 2A and 2B). Coronoid fractures (type 3) and condylar neck fractures (type 4) have seldom been reported. The various types of bad split may require different salvage approaches.
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Affiliation(s)
- S A Steenen
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), Amsterdam, Netherlands.
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Spaarne Gasthuis Haarlem, Academic Medical Centre (AMC), Amsterdam, and Academic Centre for Dentistry (ACTA) in Amsterdam, Netherlands
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50
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Thiele OC, Kreppel M, Bittermann G, Bonitz L, Desmedt M, Dittes C, Dörre A, Dunsche A, Eckert AW, Ehrenfeld M, Fleiner B, Frerich B, Gaggl A, Gerressen M, Gmelin L, Hammacher A, Haßfeld S, Heiland M, Hemprich A, Hidding J, Hölzle F, Howaldt HP, Iizuka T, Kater W, Klein C, Klein M, Köhnke RH, Kolk A, Kübler AC, Kübler NR, Kunkel M, Kuttenberger JJ, Kreusch T, Landes C, Lehner B, Mischkowski RA, Mokros S, Neff A, Nkenke E, Palm F, Paulus GW, Piesold JU, Rasse M, Rodemer H, Rothamel D, Rustemeyer J, Sader R, Scheer M, Scheffler B, Schippers C, Schliephake H, Schmelzeisen R, Schramm A, Spitzer WJ, Stoll C, Terheyden H, Weingart D, Wiltfang J, Wolff KD, Ziegler CM, Zöller JE. Moving the mandible in orthognathic surgery - A multicenter analysis. J Craniomaxillofac Surg 2016; 44:579-83. [PMID: 27017103 DOI: 10.1016/j.jcms.2016.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/11/2016] [Accepted: 01/27/2016] [Indexed: 11/30/2022] Open
Abstract
Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany.
| | - Matthias Kreppel
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
| | - Gido Bittermann
- Department of Oral and Maxillofacial Surgery (Head: Prof. R. Schmelzeisen), University Medical Center Freiburg, Germany
| | - Lars Bonitz
- Department of Craniomaxillofacial Surgery - Plastic Surgery (Head: Prof. S. Haßfeld), University Witten/Herdecke, Hospital Dortmund, Germany
| | - Maria Desmedt
- Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery (Head: Prof. M. Klein), Münster, Germany
| | - Carsten Dittes
- Department of Oral and Maxillofacial Surgery (Head: C. Dittes), Dietrich-Bonhoeffer-Hospital, Neubrandenburg, Germany
| | - Annegret Dörre
- Department of Oral and Maxillofacial Surgery (Head: A. Dörre), Chemnitz Hospital, Germany
| | - Anton Dunsche
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Dunsche), City Hospital Karlsruhe, Germany
| | - Alexander W Eckert
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery (Head: Prof. A. Eckert), Martin-Luther-University Halle-Wittenberg, Germany
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Ehrenfeld), Ludwig Maximilians University of Munich, Germany
| | - Bernd Fleiner
- Oral and Maxillofacial Surgery (Head: B. Fleiner), Im Pferseepark, Augsburg, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery (Head: Prof. B. Frerich), Facial Plastic Surgery, Rostock University Medical Center, Germany
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Gaggl), Paracelsus Medical University Salzburg, Austria
| | - Marcus Gerressen
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: PD M. Gerressen), Heinrich-Braun Hospital Zwickau, Germany
| | - Leonore Gmelin
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany
| | - Andreas Hammacher
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Hammacher and H. Sieber), Malteser Hospital St. Johannes, Duisburg, Germany
| | - Stefan Haßfeld
- Department of Craniomaxillofacial Surgery - Plastic Surgery (Head: Prof. S. Haßfeld), University Witten/Herdecke, Hospital Dortmund, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Heiland), University Medical Center Hamburg-Eppendorf, Germany
| | - Alexander Hemprich
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. A. Hemprich), Leipzig University, Germany
| | - Johannes Hidding
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hidding), Bethesda Hospital Mönchengladbach, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: Prof. F. Hölzle), RWTH Aachen University Hospital, Germany
| | - Hans-Peter Howaldt
- Department for Cranio-Maxillofacial Surgery, Plastic Surgery (Head: Prof. H.P. Howaldt), University Hospital Giessen, Germany
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery (Head: Prof. T. Iizuka), Inselspital, Bern University Hospital, Switzerland
| | - Wolfgang Kater
- Department of Oral and Maxillofacial Surgery (Head: W. Kater), Hochtaunus Hospital Bad Homburg, Germany
| | - Cornelius Klein
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Klein), Donauisar Hospital Deggendorf, Germany
| | - Martin Klein
- Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery (Head: Prof. M. Klein), Münster, Germany
| | - Robert H Köhnke
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Heiland), University Medical Center Hamburg-Eppendorf, Germany
| | - Andreas Kolk
- Department of Oral and Cranio-Maxillofacial Surgery (Head: Prof. K.D. Wolff), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander C Kübler
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. A.C. Kübler), University of Würzburg, Germany
| | - Norbert R Kübler
- Department of Cranio- and Maxillofacial Surgery (Head: Prof. N.R. Kübler), Heinrich-Heine-University Düsseldorf, Germany
| | - Martin Kunkel
- Department of Oral and Plastic Maxillofacial Surgery (Head: Prof. M. Kunkel), Ruhr-University Bochum, Germany
| | - Johannes J Kuttenberger
- Department of Oral and Maxillofacial Surgery (Head: PD J. Kuttenberger), Luzerner Kantonsspital, Switzerland
| | - Thomas Kreusch
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. T. Kreusch), Asklepios Hospital Nord, Hamburg, Germany
| | - Constantin Landes
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Landes), Sana Hospital Offenbach, Germany
| | - Bernhard Lehner
- Department of Oral and Maxillofacial Surgery (Head: B. Lehner), Health Center St. Marien, Hospital Amberg, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany
| | - Steffen Mokros
- Department of Oral and Maxillofacial Surgery (Head: S. Mokros), Ameos Hospital Halberstadt, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Neff), University of Marburg, University Hospital Giessen and Marburg, Campus Marburg, Germany
| | - Emeka Nkenke
- Department of Oral and Maxillofacial Surgery (Head: Prof. E. Nkenke), Medical University of Vienna, Austria
| | - Frank Palm
- Department of Oral and Maxillofacial Surgery (Head: Prof. F. Palm), Hospital Konstanz, Germany
| | - Gerhard W Paulus
- Department of Oral and Maxillofacial Surgery (Head: Prof. G.W. Paulus), Paracelsus Hospital Munich, Germany
| | - Jörn U Piesold
- Department of Oral and Maxillofacial Surgery (Head: PD J.U. Piesold), Helios Hospital Erfurt, Germany
| | - Michael Rasse
- Department for Cranio-, Maxillofacial and Oral Surgery (Head: Prof. M. Rasse), Medical University Innsbruck, Austria
| | - Herbert Rodemer
- Department of Oral and Maxillofacial Surgery (Head: H. Rodemer), Saarbrücken Hospital, Germany
| | - Daniel Rothamel
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
| | - Jan Rustemeyer
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Rustemeyer), Plastic Operations, Hospital Bremen, Germany
| | - Robert Sader
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: Prof. R. Sader), University Medical Centre Frankfurt/Main, Germany
| | - Martin Scheer
- Department of Oral and Maxillofacial Surgery (Head: PD M. Scheer), Hospital Minden, Germany
| | - Birgit Scheffler
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery (Head: Prof. A. Eckert), Martin-Luther-University Halle-Wittenberg, Germany
| | - Christian Schippers
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Schippers), Agaplesion Diakonie Hospital Rotenburg (Wümme), Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery (Head: Prof. H. Schliephake), George-Augusta-University, Göttingen, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery (Head: Prof. R. Schmelzeisen), University Medical Center Freiburg, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Schramm), Facial Plastic Surgery, Military Hospital of Ulm and University Hospital Ulm, Germany
| | - Wolfgang J Spitzer
- Department for Oral and Maxillofacial Surgery (Head: Prof. W. Spitzer), University Clinic of Saarland, Homburg/Saar, Germany
| | - Christian Stoll
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Stoll), Ruppiner Kliniken, Neuruppin, Germany
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery (Head: Prof. H. Terheyden), Red Cross Hospital, Kassel, Germany
| | - Dieter Weingart
- Department of Oral and Maxillofacial Surgery (Head: Prof. D. Weingart), Katharinen Hospital, Stuttgart, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Wiltfang), University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Klaus D Wolff
- Department of Oral and Cranio-Maxillofacial Surgery (Head: Prof. K.D. Wolff), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph M Ziegler
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Ziegler), St Olavs University Hospital, Norwegian University for Science and Technology, Trondheim, Norway
| | - Joachim E Zöller
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
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