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Sato M, Hamada H, Hasegawa O, Kawase-Koga Y, Chikazu D. Orthognathic Surgery in Patients With Von Willebrand's Disease: A Report of Four Cases and Literature Review. Cureus 2024; 16:e57305. [PMID: 38690476 PMCID: PMC11059190 DOI: 10.7759/cureus.57305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Von Willebrand's disease (VWD), characterized by quantitatively or qualitatively abnormal von Willebrand factor (VWF), is the most common inherited bleeding disorder. There is limited evidence of treatment using orthognathic surgery in patients with VWD. This report focuses on four patients with VWD who underwent orthognathic surgery and received Factor VIII/VWF concentrates (Confact F) preoperatively. One patient with type 3 (severe) VWD underwent delayed extubation owing to laryngeal edema and exhibited epistaxis thereafter. No perioperative complications were observed in any of the other patients. Two of the four patients were diagnosed with VWD during preoperative screening. Most young adults do not experience general anesthesia and, therefore, may not have undergone blood tests at a hospital. Thus, preoperative screening and adoption of a multidisciplinary approach to orthognathic surgery is important in patients with bleeding disorders such as VWD. Close communication between anesthetists, surgeons, and hematologists is essential to ensure effective management during the perioperative period.
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Affiliation(s)
- Marika Sato
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, JPN
| | - Hayato Hamada
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, JPN
| | - On Hasegawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, JPN
| | - Yoko Kawase-Koga
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, Tokyo, JPN
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, JPN
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Parameswaran R, Srimagesh R, Parameswaran A, Vijayalakshmi R D. Evaluating the Plantar Pressure Loading and Its Correlation to Craniocervical Posture in Subjects With Skeletal Class II Malocclusion Before and After Surgical Mandibular Advancement. Cureus 2023; 15:e48250. [PMID: 38054145 PMCID: PMC10695092 DOI: 10.7759/cureus.48250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
Class II malocclusion is one of the most prevalent types of malocclusions following Class I. The most typical postural features observed in Class II patients are extended craniocervical posture, cervical lordosis, and increased forward loading away from the body's centre of mass for compensating the mandibular deficiency and reduced airway. Its treatment involves orthodontic, functional, and orthognathic surgery. The type of treatment regimen opted for depends upon the age, severity of malocclusion, and need of the patient. Thus, appropriate intervention brings about improvement in dentition along with an overall enhancement of the body posture and plantar loading. These variables undergo a significant change whenever there is a change in the maxillomandibular relationship. The main aim of this paper is to correlate the variation in the craniocervical angulation to the plantar pressure distribution during various phases of orthodontic treatment and bilateral sagittal split osteotomy (BSSO) advancement surgery. The craniocervical angulations were determined from the lateral cephalograms of the patients using cephalometric variables and the plantar pressure was estimated using a digital quanpressurometer device (designed and patented in India by Meenakshi Academy of Higher Education and Research; patent number 390136) at each phase, i.e., during pre-treatment, pre-surgery, post-surgery, post-treatment intervals. The outcome of this study indicated that there was a significant change in the craniocervical angulation and the plantar pressure distribution pattern of the subjects before and after orthognathic surgery and it remained constant for six months after orthognathic surgery. The limitation of the study was the limited sample size. This study reveals that there was an improvement in the craniocervical angulation and plantar pressure distribution during the course of orthodontic decompensation and orthognathic surgical treatment, thus bringing about change in the individual's overall body posture and their plantar loading pattern after orthognathic surgery. Therefore, the change in the stomatognathic system by orthodontic and orthognathic treatment influences the overall muscular and functional balance of an individual thereby improving their attitude and lifestyle.
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Affiliation(s)
- Ratna Parameswaran
- Orthodontics and Dentofacial Orthopaedics, Meenakshi Academy of Higher Education and Research, Chennai, IND
| | - Radhika Srimagesh
- Orthodontics and Dentofacial Orthopaedics, Meenakshi Academy of Higher Education and Research, Chennai, IND
| | | | - Devaki Vijayalakshmi R
- Orthodontics and Dentofacial Orthopaedics, Meenakshi Academy of Higher Education and Research, Chennai, IND
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Trevisiol L, Bersani M, Lobbia G, Scirpo R, D’Agostino A. Sequencing in Orthognathic Bimaxillary Surgery: Which Jaw Should Be Operated First? A Scoping Review. J Clin Med 2023; 12:6826. [PMID: 37959291 PMCID: PMC10649175 DOI: 10.3390/jcm12216826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Bimaxillary orthognathic surgery is widely used for the correction of dentoskeletal deformities. Surgery sequencing (maxilla or mandible first) remains debated, and guidelines and consensus are lacking. This scoping review summarizes the state of the art and compares the advantages and disadvantages of both approaches. The review was conducted following PRISMA-ScR guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were searched using the PICO protocol and key words in orthognathic surgical sequencing. Four reviewers screened the records independently, and disagreement was resolved by consensus. A total of 23 records met the inclusion criteria. The advantages and disadvantages of the two approaches were compared and assessed for accuracy of reporting. Within the limitations of the present study, available evidence for the intrinsic advantages and the accuracy of the mandible-first sequence supports the choice of this approach in most cases. Nevertheless, each clinical case needs to be evaluated individually, as no dogmatic recommendations can be given for sequencing in bimaxillary orthognathic surgery.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, 37134 Verona, Italy; (M.B.); (G.L.); (R.S.); (A.D.)
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5
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Abdul NS, Minervini G. Prevalence of Temporomandibular Disorders in Orthognathic Surgery patients: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. J Oral Rehabil 2023; 50:1093-1100. [PMID: 37309105 DOI: 10.1111/joor.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Orthognathic surgery is done to treat a variety of dentofacial abnormalities, but a wide gap still remains on how it can result in temporomandibular joint dysfunction (TMD). The primary goal of this review was to assess the effects of various orthognathic surgical techniques on the emergence or exacerbation of TMJ dysfunction. METHODS A comprehensive search was conducted across several databases using Boolean operators and MeSH keywords related to temporomandibular joint disorders (TMDs) and orthognathic surgical interventions, with no limitation on the year of publication. Two independent reviewers screened the identified studies based on predetermined inclusion and exclusion criteria, followed by a risk of bias assessment using a standardised tool. RESULTS Five articles were considered for inclusion in this review. A greater number of females opted for surgical options than their male cohorts. Three studies were of prospective design, 1 of retrospective and 1 of observational type. Mobility on lateral excursion, tenderness on palpation, arthralgia and popping sounds were the TMD characteristics that showed significant differences. Overall, orthognathic surgical intervention did not show an increase in TMD signs and symptoms as compared to nonsurgical counterparts. CONCLUSION Though orthognathic surgery reported greater cases of some TMD symptoms and signs as compared to the nonsurgical cohorts in four studies, the conclusive evidence is debatable. Further studies are recommended with a longer follow-up period and greater sample size to determine the impact of orthognathic surgery on TMJ.
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Affiliation(s)
- Nishath Sayed Abdul
- Department of OMFS and Diagnostic Sciences, Faculty of Oral Pathology, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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6
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Buitenhuis MB, Klijn RJ, Rosenberg AJWP, Speksnijder CM. Reliability of 3D Stereophotogrammetry for Measuring Postoperative Facial Swelling. J Clin Med 2022; 11. [PMID: 36498711 DOI: 10.3390/jcm11237137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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7
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Amadi JU, Delitala F, Liberatore G, Scozzafava E, Brevi BC. Treatment decision-making for a post-traumatic malocclusion in an elderly patient: A case report. Dent Traumatol 2021; 37:725-731. [PMID: 33638228 PMCID: PMC8451768 DOI: 10.1111/edt.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
Traumatic dental injuries in elderly patients are a rising trend due to demographic and social changes of the population. Older dentulous patients in good health have become increasingly common. The development of a post‐traumatic malocclusion is a common sequela resulting from mandibular condyle fracture, as in the case reported in this paper. The decision‐making process led the authors to rule out conservative treatment options and to perform orthognathic surgery on an 81‐year‐old patient, an unprecedented report in the literature. At one‐year follow‐up, prophylactic therapy, a specific surgical technique, and osteotomy fixation have restored the occlusion to the pre‐traumatic condition.
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Affiliation(s)
- Jude Ugochukwu Amadi
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Maxillofacial Surgery, University of Siena, Siena, Italy
| | - Filippo Delitala
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gianmauro Liberatore
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emanuele Scozzafava
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Bruno Carlo Brevi
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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8
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Kumaran PS, Manikandan G, Anuradha V, Satish P, BalaMurugan R, Kumar AA. A Novel Modification of the Sagittal Split Osteotomy as an Access Osteotomy. Ann Maxillofac Surg 2020; 10:463-466. [PMID: 33708596 PMCID: PMC7943990 DOI: 10.4103/ams.ams_264_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Pathologies present in the central zone of the mandible are difficult to access, primarily because of the presence of the inferior alveolar nerve (IAN) and the need to remove a large corticocancellous component to reach the area of interest. Many times, this bony window is replaced as a free graft and there is complete resorption in the long term or even rejection of the graft causing a bony defect which can weaken the mandible. Furthermore, the damage to the IAN is profound. To try and avoid these comorbidities the traditional sagittal split osteotomy was modified to access a central osteoma impinging on the IAN and the successful removal of the same without any comorbidities such as paraesthesia or loss of bone structure. We believe that this modification can be used for other scenarios such as benign cysts and difficult presentations of impacted teeth.
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Affiliation(s)
- P Satish Kumaran
- Department of Oral and Maxillofacial Surgery, M. R. Ambedkar Dental College and Hospital, Bengaluru, India
| | - G Manikandan
- Department of Dentistry, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
| | - V Anuradha
- Department of Oral and Maxillofacial Surgery, M. R. Ambedkar Dental College and Hospital, Bengaluru, India
| | - Preeti Satish
- Department of Oral and Maxillofacial Surgery, M. R. Ambedkar Dental College and Hospital, Bengaluru, India
| | - R BalaMurugan
- Department of Oral and Maxillofacial Surgery, Vananchal Dental College and Hospital, Garhwa, Ranchi, Jharkhand, India
| | - Abhinav Anil Kumar
- Department of Oral and Maxillofacial Surgery, M. R. Ambedkar Dental College and Hospital, Bengaluru, India
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9
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Möhlhenrich SC, Winterhalder P, Ooms M, Heitzer M, Kilic K, Prescher A, Hölzle F, Danesh G, Modabber A. Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement. Int J Oral Maxillofac Surg 2021; 50:356-66. [PMID: 32620453 DOI: 10.1016/j.ijom.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022]
Abstract
The bilateral sagittal split osteotomy (BSSO) and high oblique sagittal split osteotomy (HSSO) are common techniques for mandibular movement in orthognathic surgery. The aim of this study was to evaluate the influence of both techniques, as well as movement distances and directions, on the position of the temporomandibular joint (TMJ). A total of 80 mandibular movements were performed on 20 fresh human cadaver heads, four on each head. Pre- and postoperative cone beam computed tomography was used to plan the surgical procedure and analyse the TMJ. Reference measurements included the anterior, superior, and posterior joint spaces, intercondylar distances and angles in the axial and coronal planes, and the sagittal, coronal, and axial angulations of the proximal segment. Only minor differences were found between the BSSO and HSSO techniques, particularly in terms of the intercondylar angle in the axial plane (P < 0.03) and the condylar angle of the proximal segment in the sagittal plane (P < 0.011). Observed changes in the TMJ were mostly opposite when moving the mandible forwards and backwards and increased with increasing movement distance. BSSO and HSSO result in similar changes in TMJ position. The extent of the movement distance influences the position of the condyle more than the osteotomy technique.
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10
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van der Helm HC, Kraeima J, Xi T, Jansma J, Schepers RH. The use of xenografts to prevent inferior border defects following bilateral sagittal split osteotomies: three-dimensional skeletal analysis using cone beam computed tomography. Int J Oral Maxillofac Surg 2020; 49:1029-1035. [PMID: 31987591 DOI: 10.1016/j.ijom.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 11/12/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The aim of this retrospective study was to investigate grafting in the osteotomy gap during bilateral sagittal split osteotomy (BSSO), using a xenograft and fibrin glue. Hard tissue defects in the inferior mandibular border were assessed using cone beam computed tomography scans taken 1 week and 1year postoperatively. The study group of 20 patients underwent bone grafting during BSSO (mean age 26.1years; mean horizontal displacement 8.5mm) and the control group of 20 patients did not (mean age 30.2 years; mean horizontal displacement 7.6mm). The mean height of the mandibular defects was significantly lower in the study group, but there was no significant difference in volume measurements between the groups. Grafting had a negligible effect on large displacements (9.0-15.0mm), which might have been due to an inadequate amount and/or positioning of the graft, or to poor dimensional stability. This may be resolved by improved graft positioning or by using a different kind of (xeno)graft.
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Affiliation(s)
- H C van der Helm
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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12
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Lin X. Correlation study of increase of pharyngeal airway space after mandibular advancement, taking natural head position into consideration. Br J Oral Maxillofac Surg 2019; 57:760-764. [PMID: 31345578 DOI: 10.1016/j.bjoms.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
The increase in the pharyngeal airway space after mandibular advancement has not been well explained, and in this study we aimed to show whether there is a correlation in the increase of pharyngeal airway space as a consequence of the mandibular advancement or of the relative change between the mandibular position and the natural head position (NHP). Fifteen patients who had bilateral sagittal split osteotomy for mandibular advancement with or without genioplasty were studied retrospectively. The primary variables of mandibular position, NHP, and pharyngeal airway space were measured in three dimensions using preoperative and postoperative cone-beam computed tomographic datasets and were compared using the paired t test. The secondary variable of pharyngeal airway space was defined as the square root of the mean cross-sectional area (CSA1/2) of the pharyngeal airway space. Pearson's correlation coefficient was used to find out whether there was a correlation between the change in CSA1/2 and the change in mandibular position, or the relative change between the mandibular position and the NHP. Volumes and minimal cross-sectional areas were increased in the pharyngeal airway space, and lengths of airways decreased. Correlation existed only between the increase in CSA1/2 and the relative change between the mandibular position and NHP. The increase in pharyngeal airway space after mandibular advancement correlated with the relative changes between the mandibular position and the NHP.
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Affiliation(s)
- Xiaozhen Lin
- Department of Oral and Maxillofacial Surgery, University of Michigan Hospital, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-0012, USA.
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13
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Frid P, Resnick C, Abramowicz S, Stoustrup P, Nørholt SE. Surgical correction of dentofacial deformities in juvenile idiopathic arthritis: a systematic literature review. Int J Oral Maxillofac Surg 2019; 48:1032-1042. [PMID: 30704836 DOI: 10.1016/j.ijom.2019.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/19/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess current evidence for the surgical correction of dentofacial deformities in patients with temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA). A systematic literature review, according to the PRISMA guidelines, was conducted. Meta-analyses, randomized controlled trials, cohort studies, observational studies, and case reports were eligible for inclusion. Exclusion criteria were no JIA diagnosis, no clearly defined outcomes, dual publications (except meta-analyses), non peer-reviewed studies, non English language publications, and animal studies. The outcome measures assessed were TMJ function, skeletal alignment, and morbidity. The database search identified 255 citations, of which 28 met the eligibility criteria. Of these, 24 were case reports or case series with a low level of evidence that did not allow for meta-analysis. Extrapolated evidence supports orthognathic surgery in skeletally mature patients with controlled or quiescent JIA and a stable dentofacial deformity. Distraction osteogenesis was recommended for severe deformities. Some authors demonstrated unpredictable postoperative mandibular growth with costochondral grafts. Alloplastic TMJ reconstruction was efficacious, but should be used cautiously in skeletally immature patients. TMJ function and skeletal alignment was improved with reconstruction by any technique and morbidity was low. The surgical correction of arthritis-induced dentofacial deformities is indicated but the level of evidence is low. Prospective multicenter studies are needed.
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Affiliation(s)
- P Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Centre of North Norway and Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
| | - C Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Boston, MS, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MS, USA
| | - S Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, and Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - P Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - S E Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Section of Oral Surgery and Oral Pathology, Aarhus University, Aarhus, Denmark
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Möhlhenrich SC, Ayoub N, Peters F, Winterhalder P, Prescher A, Hölzle F, Wolf M, Modabber A. Evaluation of the lingual fracture patterns after bilateral sagittal split osteotomy according to Hunsuck/Epker modified by an additional inferior border osteotomy using a burr or ultrasonic device. Int J Oral Maxillofac Surg 2019; 48:620-8. [PMID: 30579742 DOI: 10.1016/j.ijom.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/08/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022]
Abstract
This study was conducted to compare fracture patterns and operation times after sagittal split osteotomy (SSO) by Hunsuck/Epker approach, performed using a burr or ultrasonic device, with and without osteotomy modification. A total of 80 SSOs were performed in fresh human cadavers using a burr or ultrasonic device to investigate the influence of surgical instruments as well as an additional bone cut on the inferior border of the mandible in terms of lingual fracture patterns. The times required for osteotomy and sagittal split were measured, and postoperative cone beam computed tomography images of all splits were analyzed. Without an additional inferior osteotomy, preferred splits according to Hunsuck/Epker were achieved in 35% of cases (7/20) with the burr and 45% (9/20) with the ultrasonic instrument. The inferior modification resulted in a greater number of unwanted fracture patterns in both groups. There was no relationship between the split technique and the fracture pattern (P=0.7854). Statistically significant differences in osteotomy time were observed between burr osteotomy and modified burr osteotomy (P=0.006), as well as modified ultrasonic osteotomy (P<0.001), but not between burr and ultrasonic surgery both without the inferior cut (P=0.36). The bone cut on the inferior border did not improve split control, but rather increased the risk of unwanted fractures and extended the operation time.
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15
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İşcan D, Motro M, Acar A. Postoperative Positional and Dimensional Changes of Mandibular Canal after Bilateral Sagittal Split Set-Back Osteotomy. Turk J Orthod 2018; 30:110-117. [PMID: 30112502 DOI: 10.5152/turkjorthod.2017.17017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/14/2017] [Indexed: 11/22/2022]
Abstract
Objective This preliminary study was planned to provide information about preoperative mandibular canal (MC) position and the postoperative positional changes of MC and length in three dimensions, with the purpose of providing some assistance in reducing inferior alveolar neurosensory disturbance (IAND). Methods MC was examined on CBCT data using SimPlant Pro Standalone 13.0. MC locations were measured in all dimensions, with respect to mandibular bony borders. Results The results showed that MC is frequently located in the midthird of the ramus anteroposteriorly and superoinferiorly and in the midthird of the corpus superoinferiorly. Postoperatively, ramus width was increased, ramus length was decreased significantly, and MC was repositioned laterally and inferiorly. MC length was decreased on both sides, non-correlated with the set-back amounts. Conclusion Preoperative results may be beneficial for the prediction of MC position for surgeons, and postoperative results will be used for the following studies to correlate postoperative positional changes with IAND.
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Affiliation(s)
| | - Melih Motro
- Department of Orthodontics and Dentofacial Orthopedics, Boston University School of Dental Medicine, MA, USA
| | - Ahu Acar
- Department of Orthodontics, Marmara University School of Dentistry, İstanbul, Turkey
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16
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Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46:554-563. [PMID: 28174061 DOI: 10.1016/j.ijom.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results. A total of 4669 articles were identified; 76 relevant articles were included in the review. These studies assessed a total 3399 patients and 380 controls, with a mean age of 25.4 years. The great variety of OS techniques, examination techniques, diagnostic criteria, and imaging techniques used in the articles studied, as well as the quality of the study designs, made it difficult to compare studies and to draw conclusions. However, looking at the different aspects studied in general, it can be stated that OS seems to have little or no harmful effect on the TMJ and oral function (level of evidence: levels II, III, and IV).
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Affiliation(s)
- E C Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands.
| | - A H Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
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Promma L, Sakulsak N, Putiwat P, Amarttayakong P, Iamsaard S, Trakulsuk H, Hirunyakorn K, Suarbua S, Wattanaraeungchai Y. Cortical bone thickness of the mandibular canal and implications for bilateral sagittal split osteotomy: a cadaveric study. Int J Oral Maxillofac Surg 2017; 46:572-577. [PMID: 28089388 DOI: 10.1016/j.ijom.2016.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
Preoperative delineation of the mandibular canal and surrounding cortical bone thickness is mandatory prior to bilateral sagittal split osteotomy (BSSO). The cortical bone thickness of 101 cadaveric mandibles was measured to define the mandibular canal. The mandibles were cut at the anterior ramus, at the third, second, and first molar, and at the premolar. The cortical bone thickness was measured between the mandibular canal and inferior border, buccal cortex, and lingual cortex at each cutting point. No difference was found between the right and left sides of the mandible, or between males and females, with one exception: males were found to have thicker inferior cortical bone at the premolar site than females. The implications for BSSO are: (1) for sagittal bone cutting, the maximum cutting depth of the buccal cortex at the ramus is 4.5mm, at the second and third molars is 6.5mm, and at the first molar is 5mm; (2) for vertical bone cutting at the first molar, the maximum cutting depth from the inferior border is 7.5mm. The measurement of cortical bone thickness from cadaveric mandibles provides useful preoperative information and confirms the results of computed tomography.
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Affiliation(s)
- L Promma
- Department of Oral Surgery, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand.
| | - N Sakulsak
- Department of Anatomy, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - P Putiwat
- Department of Anatomy, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - P Amarttayakong
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - S Iamsaard
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - H Trakulsuk
- Department of Oral Surgery, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - K Hirunyakorn
- Department of Oral Surgery, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - S Suarbua
- Department of Oral Surgery, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - Y Wattanaraeungchai
- Department of Oral Surgery, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
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Riepponen A, Myllykangas R, Savolainen J, Kilpeläinen P, Kellokoski J, Pahkala R. Changes in posterior airway space and hyoid bone position after surgical mandibular advancement. Acta Odontol Scand 2017; 75:73-78. [PMID: 27832719 DOI: 10.1080/00016357.2016.1252851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate cephalometric changes in posterior airway space (PAS) and in hyoid bone distance to mandibular plane (MP) 1-3 years after bilateral sagittal split osteotomy (BSSO). MATERIAL AND METHODS The sample consisted of 36 females and 16 males who underwent mandibular advancement by BSSO. To observe sagittal changes in PAS and in hyoid bone distance to MP both pre- and postoperative cephalograms were analyzed using WinCeph® 8.0 software. For the statistical analyses paired T-test and multivariate logistic regression models were used. RESULTS By the surgical-orthognathic treatment the sagittal dimension of PAS showed variable changes but it mainly diminished when the mandibular advancement exceeded 6 mm. In most cases the hyoid bone moved superiorly by BSSO. Logistic regression models showed that males, patients with narrow PAS at the baseline, and those with counterclockwise rotation of the mandible by the treatment gained more increase in PAS. However, an increase in sagittal PAS dimension tended to relapse over time. Concerning the movement of the hyoid it was found that the more PAS increased the less hyoid moved superiorly. In males the change in hyoid position was more obvious than in females. CONCLUSION Males, patients with narrow PAS at the baseline, and those whose mandible moved in the counterclockwise direction with moderate advancement gained more retrolingual airway patency by BSSO.
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Dreiseidler T, Bergmann J, Zirk M, Rothamel D, Zöller JE, Kreppel M. Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2016; 45:1452-1458. [PMID: 27364368 DOI: 10.1016/j.ijom.2016.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/16/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
Abstract
The Obwegeser and Dal Pont modification of the bilateral sagittal split osteotomy (BSSO) is a well-established procedure in orthognathic surgery. The purpose of this retrospective study was to analyze the actual fracture patterns achieved with BSSO by Obwegeser and Dal Pont modification using postoperative cone beam computed tomography (CBCT) datasets from 100 patients. A total of 200 split osteotomies were assessed, which could be categorized into nine different split patterns. Only one of the observed split fractures (0.5%) followed exactly the fracture line described by Obwegeser and Dal Pont, whereas 40% followed the fracture line according to the Hunsuck and Epker modification and 13.5% were seen as unfavourable splits mainly running over the buccal plate. A significant correlation was found between unfavourable buccal splits and both horizontal osteotomies reaching the buccal surface at the dorsal ramus (P=0.001) and a vertical caudal bone cut end at the corpus with a buccal position (P<0.001). These results show that a complete antero-posterior horizontal osteotomy at the mandibular ramus does not lead to the intended fracture pattern, which rebuts the argument of a greater amount of bony overlap using the Obwegeser and Dal Pont modification.
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Affiliation(s)
- T Dreiseidler
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - J Bergmann
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - M Zirk
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - D Rothamel
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - J E Zöller
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - M Kreppel
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Qu Z, Wang Q, Feng X, Sheng L, Ma W, Qu W. [Application of 3D printing technique in bilateral sagittal split osteotomy]. Hua Xi Kou Qiang Yi Xue Za Zhi 2015; 33:504-508. [PMID: 26688945 PMCID: PMC7030330 DOI: 10.7518/hxkq.2015.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the application of osteotomy template manufactured via 3D printing technique in bilateral sagittal split osteotomy (BSSO). METHODS The patient group consisted of 32 patients (17 males and 15 females) with mandibular hypoplasia who underwent a BSSO setback (Hunsuck modification; 64 splits). The mean age at the time of surgery was 23.5 years (range 1.9-35 years). All patients were scanned using cone beam computed tomography (CBCT) to create a 3D model of the mandibular, and the osteotomy template of the inner horizontal ramus of mandible bone incision was manufactured via 3D printing technique. All splits underwent operation with or without the osteotomy template by either a young doctor (attending doctor) or a doctor with extensive orthognathic surgery experience (chief doctor). The time it took to perform the mandible bone incision of the inner horizontal ramus of each group was recorded. Postoperative CBCT scan was performed, and the lingual split scale was used to assess the effect of the operation. RESULTS Primary healing of incisions was observed in all patients, and no serious complications occurred. The time it took to perform the mandible bone incision of the inner horizontal ramus was significantly different in the four groups (F=30.059, P<0.05), and it was longer in the group of the attending doctor without osteotomy template than in the other three groups (P<0.05). No significant difference was observed in the other groups (P>0.05). Although all splits (n=64) were performed according to the standardized protocol, only 59.38% (38/64) of the fracture lines run according to the Hunsuck's description. By contrast, only 21.88% (14/64) run through the mandibular canal and 18.75% (12/64) was split. The database was analyzed using crosstabs and via Fisher exact test. The split pattern was influenced by the application of an osteotomy template (P<0.05). CONCLUSION The application of osteotomy template manufactured via 3D printing technique in BSSO was effective, which enabled the young doctor to complete the operation faster and with good results.
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Abstract
BACKGROUND The timing of removal of mandibular third molars (M3) in Sagittal Split Osteotomy (SSO) has been an issue of contention. The aim of this retrospective study is to identify the incidence of unfavorable fractures during SSO with the presence of M3 and to identify the association between unfavorable fractures with the factors specifically related to the M3. MATERIALS AND METHODS Retrospective analysis of consecutive bilateral sagittal split osteotomy (BSSO) patient's treatment records of 208 patients treated by a single surgeon was analyzed. The position of M3, fracture details, and demographics were collected. Descriptive statistics and Chi-square tests were employed in SPSS package. A P ≤ 0.05 was taken as significant. RESULTS There were altogether 416 SSO performed. M3 was completely impacted in 88.9% of all instances, and in 85.6% of the instances, the bulk of the M3 was identified to be above the external oblique ridge. In 59.4% of the cases, M3 was positioned in alignment with the arch as observed during surgery. There were about 27 (6.5%) instances of unfavorable splits. A statistically significant relationship was observed with M3 root morphology and axial position of M3. DISCUSSION This study for the first time has confirmed the spatial positioning of M3 as one of the several causes of unfavorable splits during SSO. An impacted M3 that lies below the oblique ridge, distoangularly/vertically oriented, with divergent/supernumerary root would cause unfavorable splits when the spreader is not used properly. Potential causes and influencing factors of the unfavorable splits are discussed.
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Affiliation(s)
- S M Balaji
- Director and Consultant, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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Abstract
The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. The technique has been in practice since the late 1800s, but did not reach widespread acceptance and use until several modifications were described in the 1960s and 1970s. Those modifications came from a desire to make the procedure safer, more reliable, and more predictable with less relapse. Those goals continue to stimulate innovation in the field today and have helped the procedure evolve to be a very dependable, consistent method of correction of many types of malocclusion. The operative surgeon should be well versed in the history, anatomy, technical aspects, and complications of the bilateral sagittal split osteotomy to fully understand the procedure and to counsel the patient.
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Affiliation(s)
- Laura A Monson
- Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Nooh N, Abdullah W, Sheta S. Anesthetic management of a patient with Bartter's syndrome undergoing bilateral sagittal split osteotomy. Saudi J Anaesth 2013; 6:419-22. [PMID: 23493184 PMCID: PMC3591567 DOI: 10.4103/1658-354x.105895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bartter's syndrome is an unusual (estimated incidence is 1.2 per million people) but important congenital form of secondary hyperaldosteronism; due to abnormalities in renal handling of electrolytes. It is associated with hypertrophy and hyperplasia of the juxtaglomerular cells, normal blood pressure, and hypokalemic alkalosis withoutedema.We present a 22-year-old woman with Bartter's syndrome underwent bilateral sagittal split osteotomy to correct mandibular prognathic. The anesthetic management of Bartter's syndrome should be relevant to the pathophysiology of the syndrome. Therefore, it should be directed toward maintaining cardiovascular stability, control of associated fluid, electrolyte and acid-base derangements, and the prevention of renal damage.
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Affiliation(s)
- Nasser Nooh
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, King Saud University, Saudi Arabia
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