Surgery-first: a new approach to orthognathic surgery

Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians

BACKGROUND

Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony.

METHODS

Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD.

RESULTS

Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness.

CONCLUSIONS

This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Retreatment of a patient: Orthognathic surgery-first approach with customized lingual appliances combined with miniplate anchorage

Orthognathic surgery is necessary when a patient's major complaints include skeletal discrepancies that cannot be corrected with orthodontic treatment alone. Currently, orthognathic surgery can be performed through conventional and surgery-first approaches. Some advantages are attributed to the surgery-first approach, such as shortened treatment time and immediate esthetic improvement. The aim of this case report is to present the retreatment of a patient presenting with a skeletal Class III malocclusion, with maxillary retrusion and mandibular protrusion, who was successfully treated with the surgery-first approach and customized lingual appliances, combined with miniplate anchorage in the postoperative orthodontic treatment. The total orthodontic treatment time was 8 months.