Tracheostomy is a surgical procedure that is commonly used to treat upper airway obstruction. In particular, patients with head and neck cancer may require elective or emergency tracheostomy because of airway obstruction due to massive bleeding of the intraoral tumor mass and rapid growth of the tumor mass in the neck area. Here, we report four cases of tracheostomy in patients with head and neck cancer with narrowed airway space and difficulty in breathing. Based on these cases and a literature review, we recommend that oral and maxillofacial surgeons and dental anesthesiologists should cooperate closely and determine the appropriate timing to perform definitive airway management for such patients during palliative treatment, along with continuous evaluation of tumor location, risk of recurrence, and airway involvement.

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

Objective: To investigate the causes of reoperation consultation, and the actual percentage and procedures of reoperation after previous orthognathic surgery. Methods: The samples consisted of 30 patients who visited our clinic for reoperation consultation from October 2015 to September 2021 (6 males and 24 females; mean age at reoperation consultation, 28.4 y). Patient’s causes of reoperation consultation were divided into “esthetic dissatisfaction,” “airway changes,” “temporomandibular disorders,” “uncomfortable occlusion,” and “other complications”. In terms of esthetic dissatisfaction, the more detailed esthetic problem was evaluated by the clinical chart, facial photographs, and radiographs. In patients who actually underwent reoperation, the actual percentage and procedures of reoperation were investigated. Results: The most prevalent causes for reoperation consultation were “esthetic dissatisfaction” (n = 21, 70.0%), followed by “airway changes” (n = 11, 36.7%), “uncomfortable occlusion” (n = 8, 26.7%), “other complications” (n = 5, 16.7%), and “temporomandibular disorder” (n = 4, 13.3%). Less than half of patients actually underwent reoperation (n = 13, 43.3%). Actual reoperation procedures included minor revision surgery, reconstruction surgery, or complete reoperation according to the patient’s need. In case of complete reoperation, more accurate and predictable results were obtained by using virtual surgical planning, customized surgical guides, titanium surgical plates made with computer-aided design and computer-aided manufacturing technique, and a 3-dimensional printing method. Conclusion: It is important to communicate with patients about expectations for facial esthetic improvement by orthognathic surgery for obtaining the patient’s postoperative satisfaction.

Orthognathic surgery is an effective surgical method to achieve functionality and facial esthetics for mandibular prognathism. If surgery is performed with a conventional method, errors may occur in the surgical preparation process and the surgical procedures, and there is a limitation in that the accuracy of surgery is determined according to the surgeon's experience and tactual sense. However, with the recent development of three-dimensional (3D) virtual planning and CAD/CAM technology, more 3D and predictable surgical planning and more accurate and time-saving surgery have become possible. The purpose of this study is to evaluate the surgical accuracy of 3D Virtual Surgery, CAD/CAM-Assisted Orthognathic surgery for Skeletal Class III Patients. The study included 18 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2020 to December 2021. To evaluate the accuracy of the virtual planning, 3D facial cone-beam computed tomography taken immediately after surgery (T1) and virtual surgery data (Tv) were superimposed in each patient. Landmarks were set on each of the maxillary segment, mandibular distal segment, and left and right mandibular proximal segment, and the difference between T1 and Tv was compared 3D on the x, y, and z-axis. (ΔT: T1−Tv). As a result, the average distance between Tv and T1 at each landmark, all landmarks except for the posterior nasal spine of the maxillary segment showed <1 mm. In particular, the differences across the x and zaxis were very small, while the difference across the y-axis tend to be large. The comparison of the position of each segment in virtual surgery and actual surgery was as follows. It can be seen that all segments were located slightly downward, and the medial pole of the mandibular proximal segment was located posterolateral and the lateral pole was located anteromedial after the actual surgery compared with the virtual planning. It means that the proximal segment was slightly rotated, but the difference was within 1 mm, so it can be considered that the surgery was accurate. Base on this study, orthognathic surgery using 3D virtual surgery planning and CAD/CAM technologies was very accurate. By applying these cutting-edge technologies to clinical practice, it was possible not only to increase the predictability of surgery but also to improve the convenience of surgery. Therefore, it is thought that it will be important for clinicians to make continuous efforts to applicate cutting-edge technologies to be developed in the future to patient diagnosis and surgery.