1
|
Hanna T, Bansal K, Ilesan RR, Buchbinder D. Hanna's Modified Sagittal Split Osteotomy (HSSO): An Alternative to Inverted L Osteotomy-Merging Function and Aesthetics for Enhanced Stability, Attractiveness, and Nerve Protection. J Clin Med 2024; 13:3438. [PMID: 38929967 PMCID: PMC11204967 DOI: 10.3390/jcm13123438] [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: 04/29/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The current high standards in orthognathic surgery demand surgical solutions that are both functionally effective and aesthetically pleasing. Our approach offers one for enhanced stability, attractiveness, and nerve protection with improved accessibility in the majority of orthognathic scenarios compared to an inverted L osteotomy. Methods: A case series is presented to illustrate the application and outcomes of HSSO, an optimised approach that combines the advantages of a transoral inverted L osteotomy with specific enhancements and increased versatility, with accessibility and exposure similar to a BSSO. Results: HSSO as a completely transoral technique, demonstrate the ability to perform significant counterclockwise rotations of the mandible, eliminating the need for trocars or skin incisions. We experinced high postoperative stability when HSSO was performed in conjunction with a three-piece LeFort 1 osteotomy on a dynamic opposing arch. In comparison to an inverted L approach, we postulated that HSSO offers advantages in stability, due to the increased segmental overlap of the proximal and distal segments of the mandible. This approach is designed to enhance the safety of the inferior alveolar nerve compared to traditional sagittal split methods. Furthermore, HSSO represents an alternative to total joint replacement in select cases of idiopathic condylar resorption and is effective for correcting mandibular asymmetries while maintaining jawline aesthetics. This is achieved through the manipulation of the mandibular angle, ramus height, and inferior border without creating a step deformity in the soft tissue. Conclusions: The outcomes of HSSO highlight its capacity to deliver predictable, functional, and aesthetically pleasing results, offering a viable alternative to more traditional orthognathic techniques.
Collapse
Affiliation(s)
- Todd Hanna
- Private Practice, Hanna Face and Jaw PC, New York, NY 10029, USA;
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA; (K.B.)
| | - Ketan Bansal
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA; (K.B.)
- Department of Oral and Maxillofacial Surgery, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
| | - Robert Radu Ilesan
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA; (K.B.)
- Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Harmoniestraat 48, 2018 Antwerp, Belgium
- Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
- Faculty of Medicine & Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Daniel Buchbinder
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA; (K.B.)
| |
Collapse
|
2
|
Wang S, Ge W, Qi L, Cao N, Meng J, Zhang L. Mandible-First Sequencing Increase Surgical Accuracy for Patients With Skeletal Class II Malocclusion Concomitant With Unstable Condyle-Fossa Relation. J Craniofac Surg 2023:00001665-990000000-01255. [PMID: 38055333 DOI: 10.1097/scs.0000000000009890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to explore whether mandible-first sequencing increases the surgical accuracy in bimaxillary orthognathic surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation. A retrospective evaluation of 19 patients who had undergone virtually planned double-splint orthognathic surgery with different operation sequences was performed: maxilla-first (n=9) or mandible-first (n=10) surgery. The centroid position, translational, and rotational differences in the maxilla were evaluated by comparing the virtual plans with actual results. The stability was assessed by comparing the actual results with the follow-up outcomes 6 months postoperatively. The accuracy of the maxilla centroid position was improved in mandible-first sequencing surgery: mandible-first 1.87±0.94 mm versus maxilla-first 2.70±0.75 mm (P<0.05). Moreover, no significant difference was detected in the translational and orientational discrepancies between the 2 groups. Neither sequencing procedure differed in the overall stability: maxilla-first (1.48±1.13 mm) versus mandible-first (1.57±0.90 mm). This study indicated that the mandible-first surgery leads to a more accurate maxilla position than the maxilla-first surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation.
Collapse
Affiliation(s)
- Shoupeng Wang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Weiwen Ge
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Lei Qi
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Ningning Cao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Jian Meng
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Lei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| |
Collapse
|
3
|
Tabrizi R, Sarrafzadeh A, Shafiei S, Moslemi H, Dastgir R. Does maxillomandibular fixation affect skeletal stability following mandibular advancement? A single-blind clinical trial. Maxillofac Plast Reconstr Surg 2022; 44:19. [PMID: 35522330 PMCID: PMC9076785 DOI: 10.1186/s40902-022-00350-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background The stability of the results remains a significant concern in orthognathic surgeries. This study aimed to assess the amount of relapse following mandibular advancement with/without maxillomandibular fixation (MMF). Materials and methods A single-blind clinical trial was conducted on patients with mandibular retrognathism who underwent BSSO for mandibular advancement and Lefort I maxillary superior repositioning. Patients were randomly divided into two groups of treatment (MMF) and control (no MMF). In the treatment group, MMF was performed for 2 weeks; meanwhile, MMF was not performed in the control group, and only guiding elastics were applied postoperatively. Lateral cephalograms were obtained preoperatively (T1), immediately after surgery (T2), and at 1 year postoperatively (T3). The distance from points A and B to the X and Y plane were measured to identify the amount of vertical and horizontal relapse in 1 year as a primary outcome. An independent t-test was applied in order to find differences in outcomes between the control and treatment groups. Results Fifty-eight patients were evaluated in two groups (28 patients in the MMF group and 30 in the no-MMF group). The magnitude of mandibular advancement following BSSO was 7.68±1.39 mm and 7.53±1.28, respectively, without significant difference among the groups (p= 0.68). The mean sagittal and vertical changes (relapse) at point B were significantly different between the two groups at 1-year follow-up after the osteotomy (p=0.001 and p=0.05, respectively). Conclusion According to the results of this study, patients with short-term MMF following BSSO for mandibular advancement benefit from significantly greater skeletal stability in the sagittal and vertical dimensions.
Collapse
Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Arash Sarrafzadeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Arak University of Medical Sciences, Arak, Iran.
| | - Shervin Shafiei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Hamidreza Moslemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Ramtin Dastgir
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| |
Collapse
|
4
|
Can S, Basa S, Varol A. Comparison of bicortical, miniplate and hybrid fixation techniques in mandibular advancement and counterclockwise rotation: A finite element analysis study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e7-e14. [PMID: 33848666 DOI: 10.1016/j.jormas.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/28/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to evaluate biomechanical stability and stress distribution of five different fixation types with finite element analysis using 10-mm advancement with or without counterclockwise rotation of the mandible. MATERIALS AND METHODS After sagittal split osteotomy, 10-mm advancement was performed in the first group and 10-mm advancement and 10-degree counterclockwise rotation were performed in the second group. One miniplate (M-1), two-miniplate (M-2), one miniplate and a bicortical screw (H), l-shaped bicortical screw (B-1), and inverted l-shaped bicortical screw (B-2) systems were placed. Totally, 120 N force was applied to the models at a 45-degree angle from the lower edge of the symphysis. RESULTS The highest values on fixation were seen with miniplate, while the mean values were obtained with bicortical screw system. The highest values on bone were achieved using bicortical screws. One miniplate (M-1) showed both the highest and mean displacement. The highest values in counterclockwise-rotated models increased in all parameters, compared to non-rotated models. CONCLUSION In cases in which passive alignment between segments and adequate bone contact are ensured, inverted l-shaped bicortical screw, two-miniplate, or hybrid systems are recommended.
Collapse
Affiliation(s)
- Serhat Can
- Specialist, Bahcesehir University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.
| | - Selcuk Basa
- Professor & Dean, Bahcesehir University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Altan Varol
- Professor, Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| |
Collapse
|
5
|
One-year stability of the mandibular advancement and counterclockwise rotation for correction of the skeletal class II malocclusion and high mandibular plane angle: Dental and skeletal aspect. Biomed J 2021; 45:206-214. [PMID: 35346613 PMCID: PMC9133256 DOI: 10.1016/j.bj.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to evaluate the stability on dental and skeletal aspect after surgical advancement and counterclockwise rotation for the correction of the mandibular deficiency in patients with high mandibular plane angle (MPA). Methods We analyzed the records of patients who had undergone surgical treatment for dentofacial deformities with mandibular deficiency and high MPA. Clinical and radiological data were taken 1 month before surgery (T0), 6 weeks after surgery (T1) and 1 year after surgery (T2). Cephalometric values of the MPA were recorded and compared. The cephalometric changes in the different time periods were defined as follows: A: postsurgical changes (T0–T1), B: one-year changes (T1–T2), and C: short term changes (T0–T2). Results Twenty-seven patients had prominent mandibular deficiency with an MPA of over 35° (high angle). The mean age of patients at surgery was 29.7 years. Seven patients had a single jaw procedure, 20 patients had bilateral sagittal split osteotomy (BSSO) combined with a Le Fort I osteotomy, and 14 patients had additional genioplasty. MPA values differed significantly between the time periods (p < 0.05) with an observed relapse of the angle. However, satisfactory clinical improvement was achieved in the dental and skeletal presentation. The overjet improvement was evident from 8.815 ± 2.085 mm (T0) to 3.426 ± 1.253 mm (T2). Conclusion Counterclockwise surgical advancement of the mandible to correct mandibular deficiency in patients with a high mandibular plane angle showed an overall acceptable stability during one-year follow-up.
Collapse
|
6
|
Thiem DGE, Schneider D, Hammel M, Saka B, Frerich B, Al-Nawas B, Kämmerer PW. Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis. Clin Oral Investig 2020; 25:3315-3327. [PMID: 33155066 PMCID: PMC8060167 DOI: 10.1007/s00784-020-03664-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/28/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. MATERIALS AND METHODS In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0-4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. RESULTS Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients' self-perception (85.4%), with 60.4% of patients opting for surgery again. CONCLUSIONS Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. CLINICAL RELEVANCE Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.
Collapse
Affiliation(s)
- Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany. .,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | | | - Bassam Saka
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany.,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| |
Collapse
|
7
|
Vishwanath M, Janakiraman N, Steinbacher DM, Uribe F. Orthodontic and surgical management of a patient with severe mandibular deficiency and asymmetry with condylar hypoplasia using 3-dimensional surgical planning in combination with a modified surgery-first approach. Am J Orthod Dentofacial Orthop 2020; 158:426-442. [PMID: 32862937 DOI: 10.1016/j.ajodo.2019.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 10/23/2022]
Abstract
Progressive improvements in digital technology and surgical techniques have synergized the speed, predictability, and favorable outcomes for patients undergoing surgical-orthodontic treatment with handicapping dentofacial deformities. This case report will demonstrate the management of a patient with severe mandibular hypoplasia, condylar hypoplasia, and mandibular asymmetry. The dentofacial deformity, and consequently, the unaesthetic facial appearance, led to psychosocial stress, symptoms of excessive daytime sleepiness, and functional limitations, especially related to mandibular movements. A modified surgery-first approach was used, which was successfully performed using computer-assisted surgical planning. Postsurgical orthodontics was accomplished with the aid of temporary skeletal anchorage mini-plates. An additional alloplastic enhancement of the chin addressed the severe microgenia, which the osseous advancement could not achieve. This resulted in a total advancement of the pogonion by 26 mm yielding a remarkable improvement in the patient's facial esthetics. Furthermore, a considerable improvement in mandibular function and reduction in daytime sleepiness occurred. The severe malocclusion with a discrepancy index value of 47 was treated to a successful final occlusion in 21 months of treatment time.
Collapse
Affiliation(s)
- Meenakshi Vishwanath
- Department of Growth and Development, Orthodontic Section, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebr.
| | - Nandakumar Janakiraman
- Department of Orthodontics, University of Louisville School of Dentistry, Louisville, Ky
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn
| | - Flavio Uribe
- Department of Craniofacial Sciences, Division of Orthodontics, University of Connecticut School of Dental Medicine, Farmington, Conn
| |
Collapse
|
8
|
Boss H, Park JH, Carlotti A, Papademetriou M, Grubb J. Mandibular micrognathia and vertical maxillary excess correction with combination LeFort I and inverted L osteotomies. Am J Orthod Dentofacial Orthop 2020; 157:704-718. [PMID: 32354443 DOI: 10.1016/j.ajodo.2019.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
A 34-year-old woman with mandibular micrognathia, vertical maxillary excess, and an open bite characterized by a "bird-face" deformity was treated with orthodontics combined with LeFort I and bilateral inverted L osteotomies. The total treatment time was 16 months. Her occlusion and facial appearance were significantly improved by a surgical-orthodontic plan. This case report presents the discussion of a unique and complex orthognathic surgical case and the myriad of orthodontic and surgical considerations that it involved.
Collapse
Affiliation(s)
- Hunter Boss
- Private Practice, Austin, Tex; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jae Hyun Park
- Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz.
| | - Albert Carlotti
- Private Practice, Austin, Tex; Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz
| | - Michael Papademetriou
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz
| | - John Grubb
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz
| |
Collapse
|
9
|
Chen Y, Zhang J, Han Y, Ferraro N, August M. Interaction analysis of risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:350-355. [DOI: 10.1016/j.ijom.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/23/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
|
10
|
Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Do Patients With Different Mandibular Plane Angles Have Different Time to Relapse After Bilateral Sagittal Osteotomy With Mandibular Advancement? J Oral Maxillofac Surg 2019; 78:455-466. [PMID: 31629758 DOI: 10.1016/j.joms.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE This study sought to answer the following question: Do patients with different mandibular plane angles (MPAs) have a different time to relapse after mandibular advancement with bilateral sagittal split osteotomy? MATERIALS AND METHODS We performed a retrospective cohort study of patients who underwent bilateral sagittal split osteotomy advancement at Massachusetts General Hospital between 2005 and 2017. The primary predictor variable was MPA, categorized as low (<25°), medium (between 25° and 35°), or high (>35°). The outcome variable was time to relapse (≥2-mm posterior change at the B point). Other covariates included gender, age, temporomandibular joint symptoms, bimaxillary surgery, direction of mandibular rotation, magnitude of advancement, genioplasty, and fixation method. Time to relapse was estimated using the Kaplan-Meier method. Cox and parametric regressions for interval-censored data were performed. P < .05 was considered statistically significant. RESULTS The sample was composed of 58 patients (40 female patients), with a mean age of 26.1 ± 4.9 years, grouped as follows: low MPA, n = 15; medium MPA, n = 26; and high MPA, n = 17. Clinically significant relapse was found in 18 patients (31%). Age, temporomandibular joint symptoms, counterclockwise rotation, and magnitude of advancement were statistically significantly different among the 3 groups. When we assessed time to relapse, the Kaplan-Meier method showed that high-MPA patients had a longer mean time at risk and higher estimated probabilities of relapse at different time points compared with low- and medium-MPA patients (P < .05). However, this association was not significant in Cox and parametric regressions. CONCLUSIONS Our results suggest that clinically significant relapse was found during the first postoperative year in low-MPA patients and from 2 to 5 years postoperatively in high-MPA patients. Multivariate regression analyses did not show a significant association between MPA and time to relapse, suggesting that other covariates may play a role in the observed time to relapse.
Collapse
Affiliation(s)
- Youbai Chen
- Resident, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Jie Zhang
- Research Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Naman Rao
- Student, MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Yan Han
- Department Head and Professor, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nalton Ferraro
- Associate Professor, Harvard School of Dental Medicine, Boston, MA
| | - Meredith August
- Director, Center for Applied Clinical Investigation, and Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and Associate Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
| |
Collapse
|
11
|
Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Independent risk factors for long-term skeletal relapse after mandibular advancement with bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2019; 49:779-786. [PMID: 31601473 DOI: 10.1016/j.ijom.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/03/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this retrospective cohort study was to identify the independent risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Univariate and multivariate linear regression analyses were performed including nine common risk factors for relapse as independent variables and horizontal/vertical long-term (≥2 years) skeletal relapse as dependent variables. Ninety-six patients were analyzed; 66 were female (68.8%) and the average age of the patients was 29.7±10.5 years. Over an average follow-up of 3.8±1.8 years after an initial mandibular advancement of 8.8±2.4 mm, long-term skeletal relapse of 1.6±1.0 mm horizontal and 0.9±0.7 mm vertical was found. Multivariate analysis identified age, preoperative mandibular plane angle (MPA), bimaxillary surgery, counterclockwise mandibular rotation, and the magnitude of mandibular advancement to be significantly associated with horizontal long-term skeletal relapse. Preoperative MPA, counterclockwise mandibular rotation, and the magnitude of mandibular advancement were significantly associated with vertical long-term skeletal relapse. Thus preoperative MPA, the magnitude of mandibular advancement, and counterclockwise mandibular rotation of the mandible were found to be independent risk factors for both horizontal and vertical long-term skeletal relapse. Although long-term skeletal relapse cannot be avoided entirely, understanding the independent risk factors and their contributions will optimize treatment planning and long-term stability.
Collapse
Affiliation(s)
- Y Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - J Zhang
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - N Rao
- Harvard Medical School, Boston, Massachusetts, USA
| | - Y Han
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - N Ferraro
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - M August
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA.
| |
Collapse
|
12
|
Cillo JE, Dattilo DJ. Maxillomandibular Advancement for Severe Obstructive Sleep Apnea Is a Highly Skeletally Stable Long-Term Procedure. J Oral Maxillofac Surg 2019; 77:1231-1236. [DOI: 10.1016/j.joms.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/06/2019] [Accepted: 01/06/2019] [Indexed: 01/30/2023]
|
13
|
Kang YJ, Cha BK, Choi DS, Jang IS, Kim SG. Botulinum toxin-A injection into the anterior belly of the digastric muscle for the prevention of post-operative open bite in class II malocclusions: a case report and literature review. Maxillofac Plast Reconstr Surg 2019; 41:17. [PMID: 31093487 PMCID: PMC6484054 DOI: 10.1186/s40902-019-0201-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Class II malocclusion patients with hyperdivergent facial types are characterized by short mandibular body lengths and anterior open bite. Accordingly, the treatment for hyperdivergent skeletal class II malocclusion is a lengthening of the mandibular body length and a counterclockwise rotation of the mandible. To prevent post-operative relapse, botulinum toxin-A (BTX-A) injection can be a retention modality. Case presentation A class II open-bite patient received BTX-A injection to the anterior belly of her digastric muscle for the prevention of post-operative relapse. The relapse was evaluated via a clinical examination and a lateral cephalometric radiograph after the completion of post-surgical orthodontic treatment. The patient showed stable occlusion without any signs of relapse at 15 months post-operatively. Conclusion In this case presentation, a single injection into the anterior belly of the digastric muscle was sufficient for the prevention of post-operative open bite.
Collapse
Affiliation(s)
- Yei-Jin Kang
- 1Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 28644 Republic of Korea
| | - Bong Kuen Cha
- 2Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, 28644 Republic of Korea
| | - Dong Soon Choi
- 2Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, 28644 Republic of Korea
| | - In San Jang
- 2Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, 28644 Republic of Korea
| | - Seong-Gon Kim
- 1Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 28644 Republic of Korea
| |
Collapse
|
14
|
Vale F, Rodrigues ML, Francisco I, Roseiro A, Santos I, Caramelo F, Rodrigues MJ. Short‐term pharyngeal airway space changes after mandibular advancement surgery in Class
II
patients—a two‐dimensional retrospective study. Orthod Craniofac Res 2019; 22:81-86. [DOI: 10.1111/ocr.12264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Francisco Vale
- Institute of OrthodonticsFaculty of MedicineUniversity of Coimbra Coimbra Portugal
| | | | - Inês Francisco
- Institute of OrthodonticsFaculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Ana Roseiro
- Institute of OrthodonticsFaculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Inês Santos
- Department of Maxillofacial SurgeryHospital of the University of Coimbra Coimbra Portugal
| | - Francisco Caramelo
- Institute of Clinical and Biomedical Research of Coimbra (iCBR)Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Maria João Rodrigues
- Institute of Temporomandibular Disorders and Orofacial PainFaculty of MedicineUniversity of Coimbra Coimbra Portugal
| |
Collapse
|
15
|
Liebregts J, Baan F, van Lierop P, de Koning M, Bergé S, Maal T, Xi T. One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Sci Rep 2019; 9:3000. [PMID: 30816184 PMCID: PMC6395738 DOI: 10.1038/s41598-019-39250-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/17/2019] [Indexed: 11/09/2022] Open
Abstract
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.
Collapse
Affiliation(s)
- Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter van Lierop
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
| |
Collapse
|
16
|
Ti-24Nb-4Zr-8Sn Alloy Pedicle Screw Improves Internal Vertebral Fixation by Reducing Stress-Shielding Effects in a Porcine Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8639648. [PMID: 29581988 PMCID: PMC5822754 DOI: 10.1155/2018/8639648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
To ensure the biomechanical properties of Ti-24Nb-4Zr-8Sn, stress-shielding effects were compared between Ti-24Nb-4Zr-8Sn and Ti-6Al-4V fixation by using a porcine model. Twelve thoracolumbar spines (T12–L5) of 12-month-old male pigs were randomly divided into two groups: Ti-24Nb-4Zr-8Sn (EG, n = 6) and Ti-6Al-4V (RG, n = 6) fixation. Pedicle screw was fixed at the outer edge of L4-5 vertebral holes. Fourteen measuring points were selected on the front of transverse process and middle and posterior of L4-5 vertebra. Electronic universal testing machine was used to measure the strain resistance of measuring points after forward and backward flexion loading of 150 N. Meanwhile, stress resistance was compared between both groups. The strain and stress resistance of measurement points 1, 2, 5, 6, 9, and 10–14 in Ti-24Nb-4Zr-8Sn fixation was lower than that of Ti-6Al-4V fixation after forward and backward flexion loading (P < 0.05). The strain and stress resistance of measurement points 3, 4, 7, and 8 was higher in Ti-24Nb-4Zr-8Sn fixation than that of Ti-6Al-4V fixation (P < 0.05). Stress-shielding effects of Ti-24Nb-4Zr-8Sn internal fixation were less than that of Ti-6Al-4V internal fixation. These results suggest that Ti-24Nb-4Zr-8Sn elastic fixation has more biomechanical goals than conventional Ti-6Al-4V internal fixation by reducing stress-shielding effects.
Collapse
|
17
|
Stability and surgical complications in segmental Le Fort I osteotomy: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1071-1087. [DOI: 10.1016/j.ijom.2017.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022]
|