Facial Appearance and Psychosocial Features in Orthognathic Surgery: A FACE-Q- and 3D Facial Image-Based Comparative Study of Patient-, Clinician-, and Lay-Observer-Reported Outcomes

Lin

et al. 2019

Self Cite

The mandibular proximal ramus segments should be moved and rotated during orthognathic surgery-based skeletofacial reconstruction for the correction of challenging patients with facial asymmetry and malocclusion, but quantitative data regarding this rotation were not sufficient to date. This 3D computer-assisted study measured the proximal ramus segment rotation after 3D simulation-guided two-jaw surgery in patients with facial asymmetric deformity and class III malocclusion (n = 31). Using 3D mandible models and a reliable proximal ramus segment-related plane, angular changes in pitch, roll and yaw directions were measured before and one month after surgery. Significant rotational changes (p < 0.01) were observed in the left and right sides and overall proximal ramus segments after surgery, with absolute differences of 4.1 ± 3.0 (range −7.8 to 6.9), 2.8 ± 2.3 (−8.8 to 5.0), and 2.7 ± 2.4 (−6.6 to 9.9) degrees in pitch, roll, and yaw rotations, respectively. Numbness and mouth opening limiting occurred within the first 6 months after surgery but the patients had an unremarkable long-term postoperative course, with no revisionary surgery required. This study contributes to the multidisciplinary-related literature by revealing that proximal ramus segment rotation and rigid fixation with no postoperative intermaxillary immobilization was practicable in skeletofacial surgery for the successful treatment of asymmetric deformity and class III malocclusion.

Section: Discussionmentioning

confidence: 99%

The outcome of skeletofacial reconstruction with mandibular rotation for management of asymmetric skeletal class III deformity: A three-dimensional computer-assisted investigation

Lin

et al. 2019

Self Cite

“…Therefore, it may be possible that the presence of poor or the lack of significance for the tested correlations may not be associated to the incapacity of each tool to detect relevant features from the patient (nose and nostril appearance) and the abnormalities (clefts versus dentofacial deformities versus normal individuals). Studies have reported that the appraisal of correlations between two different outcome measurement tools has implications for the ongoing discussions regarding the correct interpretation and application of each existing tool in clinical and research settings 18,39,40 . Therefore, further investigation is important to improve our understanding of the assessed tools by testing further predefined hypotheses about expected correlations, as it would attenuate the risk of bias and assist researches to avoid substitute justifications after data analysis, as defined before our data collection.…”

Section: Discussionmentioning

confidence: 99%

Patient- and 3D morphometry-based nose outcomes after skeletofacial reconstruction

Chou

Seo

et al. 2020

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Patient satisfaction with the shape and appearance of their nose after orthognathic surgery-based skeletofacial reconstruction is an important, but often overlooked, outcome. We assessed the nose-related outcomes through a recently developed patient-reported outcome instrument and a widely adopted 3D computer-based objective outcome instrument, to verify any correlation in the results produced by these tools. We collected FACE-Q nose appearance reports (2 scales) and 3D nasal morphometry (10 parameters) from patients with class III skeletal pattern and congenital cleft lip palate deformity (n = 23) or developmental dentofacial deformity (n = 23) after (>12 months) skeletofacial reconstruction. The cleft and dentofacial cohorts demonstrated significantly (p < 0.001) poorer satisfaction scores with regard to the FACE-Q nostrils scale than the normal age-, gender-, and ethnicity-matched subjects (n = 107), without any significant difference in FACE-Q nose scale. The cleft cohort had significantly (p < 0.001) smaller nasal length, nasal tip projection, and columellar angle and greater nasal protrusion, alar width, and columellar-labial angle values than the dentofacial and normal cohorts; however, there were no significant differences between the dentofacial versus normal cohorts. The FACE-Q nose and nostrils scales were significantly (p < 0.001; r = −0.26-0.27) correlated to the results of the 3D morphometric analysis, with regard to nasal length, alar width, columella angle, and columellar-labial angle parameters. This study revealed differences in satisfaction with the appearance of the nose according to the type of underlying deformity, and demonstrated a significant correlation (low correlation coefficients) between the patient-reports and 3D image-based outcome measure tools, which has implications for multidisciplinary-centered research, auditing, and clinical care. Facial deformities associated with abnormal maxillo-mandibular relationships, such as congenital cleft lip and palate and developmental dentofacial deformities, significantly affect oral function and facial aesthetics 1,2. Skeletofacial reconstruction using orthognathic surgery principle is a successful treatment modality for these abnormalities 3-5. However, a number of post-surgical facial modifications are the primary causes of concern among the patients, particularly changes in the nasal morphology 6. A growing number of studies have addressed this issue by adopting three-dimensional (3D) nasal measurements 6-15 , but the effects of skeletofacial reconstruction are beyond these imaging-guided outcome metrics 1,4,5. The patient satisfaction with the appearance of their nose is an important, albeit often overlooked, outcome parameter after orthognathic surgery. Therefore, including a patient's self-perception by employing patient-reported outcome (PRO) techniques may help clinicians to understand the health-related concerns of the patient 16,17. Literature reviews 4,5 have revealed that a plethora of PRO instruments have been utilized to primaril...

“…We also verified the subjective perceptions from blinded raters using the panel assessment, an outcome measure tool frequently embraced in OGS literature 49 . Interestingly, the post-OGS panel assessment-based results revealed that raters appraised the patients treated with 3D simulation as more symmetrical than 2D planning-treated patients, proposing that the facial changes after OGS treatment impacted the raters' perceptions.…”

Section: Lateral Lower Chin N (%)mentioning

confidence: 99%

Outcome of facial contour asymmetry after conventional two-dimensional versus computer-assisted three-dimensional planning in cleft orthognathic surgery

Hsu

Pai

et al. 2020

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Computer-assisted 3D planning has overcome the limitations of conventional 2D planning-guided orthognathic surgery (OGS), but difference for facial contour asymmetry outcome has not been verified to date. This comparative study assessed the facial contour asymmetry outcome of consecutive patients with unilateral cleft lip and palate who underwent 2D planning (n = 37)-or 3D simulation (n = 38)-guided OGS treatment for correction of maxillary hypoplasia and skeletal Class III malocclusion between 2010 and 2018. Normal age-, gender-, and ethnicity-matched individuals (n = 60) were enrolled for comparative analyses. 2D (n = 60, with 30 images for each group) and 3D (n = 43, with 18 and 25 images for 2D planning and 3D simulation groups, respectively) photogrammetric-based facial contour asymmetry-related measurements were collected from patients and normal individuals. The facial asymmetry was further verified by using subjective perception of a panel composed of 6 blinded raters. On average, the facial contour asymmetry was significantly (all p < 0.05) reduced after 3D virtual surgery planning for all tested parameters, with no significant differences between post-OGS 3D simulation-related values and normal individuals. No significant differences were observed for pre-and post-OGS values in conventional 2D planning-based treatment, with significant (all p < 0.05) differences for all normal individuals-related comparisons. This study suggests that 3D planning presents superior facial contour asymmetry outcome than 2D planning.Orthognathic surgery (OGS) plays a key role for successful management of a myriad of facial deformities associated with malocclusion, with facial asymmetry feature being most frequently associated with skeletal class III malocclusion 1-3 . Particularly, patients with unilateral cleft lip and palate differ from the noncleft population, because they have a congenital orofacial defect compromising both the bone and soft tissues on the lesion side 4-6 , which may be expressed as facial asymmetry 7-15 . Skeletal mature patients with clefts frequently presents with maxillomandibular disharmony (maxillary hypoplasia and skeletal class III malocclusion) which requires OGS treatment 7-15 . As residual facial asymmetry after OGS treatment may negatively impact patients' perceptions about outcome requiring further revisionary surgical interventions [16][17][18][19] , the significance of preoperative prediction of this deformity should not be underestimated 15,16,20 . Therefore, it is of paramount that an accurate diagnosis of asymmetry is accomplished preoperatively for that a precise surgical planning and execution is performed 7,15,16,20 .In this setting, OGS planning has evolved over the past decades 15-24 . Traditionally, OGS planning has been constructed on two-dimensional (2D) cephalometry, 2D photographic analysis, articulators, and dental models 21,22 . However, this planning modality presents limitations for challenging clinical scenarios such as patients with clefts associated with malocclusion a...