Controversies in Orthognathic Surgery

Pérez, Daniel; Liddell, Aaron

doi:10.1016/j.coms.2017.07.008

Cited by 17 publications

(11 citation statements)

References 44 publications

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“…Orthognathic surgery is a well-established method to correct various forms of dentofacial deformity. 19 Usually, the maxilla is more vascular than the mandible; blood loss during maxillary surgery therefore accounts for a large percentage of the total blood loss, especially in bimaxillary OS settings. 14 Unlike other current meta-analysis, 3,5,15 this study evaluated only bimaxillary OS surgery, in order to decrease the impact of procedure on the pooled effect.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

2020

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Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

2020

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“…9 VSP has revolutionized orthognathic surgery over the last couple decades, as it allows for improved diagnostic ability and treatment precision. 10,11 Traditional surgical planning involves using clinical records, two-dimensional radiographs, photographs, and model surgery. Continued improvement of medical modeling software has allowed for the transfer of clinical information to a virtual platform that ultimately results in highly accurate surgical outcomes without making time-consuming models [11][12][13] (►Fig.…”

Section: Patient Assessmentmentioning

confidence: 99%

“…Most notably, the main limitation of the SARPE procedure is a high incidence of reported relapse. 11,14…”

Section: Surgical Modificationsmentioning

confidence: 99%

“…Advances in orthodontic simulation via dental models and planning software allow for this "surgery first" technique, which is gaining popularity. 11 Peiró-Guijarro et al, in a large comparative study, found "surgery first" patients completed their treatment 6 months sooner than those in which conventional orthodontics were used prior to surgery. 17 Cases that would prohibit the "surgery first" technique include those with a significant amount of dental compensation, defined as the natural attempt to achieve normal interarch relationship with varying skeletal discrepancies, as well as severe craniofacial deformities that rely on decompensation to establish a definite surgical plan.…”

Section: Sequencing Of Treatmentmentioning

confidence: 99%

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Orthognathic Surgery—LeFort I Osteotomy

et al. 2021

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Orthognathic surgery is a complex type of facial surgery that can have a profound impact on a patient's occlusal function and facial aesthetics. Close collaboration between the maxillofacial surgeon and an orthodontist is required, and the surgical team must have a strong foundation in facial analysis and firm understanding of the maxillofacial skeleton to achieve surgical success. Herein, we review the maxillary LeFort I osteotomy as it pertains to orthognathic surgery, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.

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“…According to Perez and Liddell 23 , there are few reliable data regarding the possibility of the CPD maintaining the condyle in the desired position during orthognathic surgery or if this is relevant for success. More important than which CPD is the best, is to be certain with respect to the passive position of the proximal segment 23. The aim of the present study was to verify the occurrence of changes in postoperative condylar positioning in artificial skulls with a skeletal Class II maxillomandibular relation submitted to bilateral sagittal split osteotomy when the method of cephalometric data and surgical plan transfer were used 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Condylar positioning in orthognathic surgery

Neto¹,

Gonçales²,

Nogueira³

et al. 2019

Braz. J. Oral Sci.

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Aim: Orthognathic surgery aims to correct facial skeletal deformities and the correct condylar positioning is very important for stable results. The aim of the present study was to verify the occurrence of changes in the postoperative condylar positioning in artificial skulls with a skeletal Class II maxillomandibular relationship submitted to bilateral sagittal split osteotomy when the method of cephalometric data transfer was used. Methods: Ten skeletal Angle class II polyurethane skulls were used with metallic markers in the articular surfaces of the temporomandibular joint and mandibular condyles. The skulls were submitted to preoperative and postoperative cone beam computed tomography before and after the bilateral sagittal split osteotomy. To verify the condylar positioning, measurements between the distances of the markers at the temporal bones and mandibular condyles were taken in the coronal and sagittal views by the DISTANCE tool of the iCat Vision software. All measurements were obtained by one examiner in the preoperative and postoperative CBCTs, tabulated and submitted to statistical analysis by the Wilcoxon test with a level of significance of 5% (p<0,05). After 15 days of the completion of the first data collection, all measurements were redone to determine the random and systematic error by the Intraclass Correlation Coefficient. Results: With the exception of the average of the lateral-medial distance (from the measurements between the medium left markers only), the averages of the anterior-posterior distances (only in the left posterior and lateral right markers) and the vertical average (only in the central markers) showed no statistically significant differences between the preoperative and postoperative distances of the metallic markers. Conclusion: Even when using the method of cephalometric data transfer, variation of the condylar positioning occurred between the preoperative and postoperative periods. This variation occurred only in a few points of the mandibular condyles.

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Controversies in Orthognathic Surgery

Cited by 17 publications

References 44 publications

Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

Orthognathic Surgery—LeFort I Osteotomy

Condylar positioning in orthognathic surgery

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