Skeleton First in Surgical Treatment of Facial Disharmony

Yang, Jing; Lei, Jiaqi; Wu, Yi; Lu, Jiawen; Ke, Ronghu; Yu, Qiangshan; Mu, Xin

doi:10.1097/scs.0000000000001463

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Although the surgery-first approach has been widely accepted in recent years for immediate esthetic improvement of skeletal discrepancies,9 it has definite limitations in treating patients with facial asymmetries, especially when they have been diagnosed with the Y-type or A-type asymmetry accompanied by skeletal yawing. Targeted 3D decompensation is still necessary for sufficient surgical jaw movement and for maximum surgical stability, particularly in patients with such complicated facial asymmetry.…”

Section: Introductionmentioning

confidence: 99%

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

et al. 2017

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Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

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Section: Introductionmentioning

confidence: 99%

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

et al. 2017

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“…4,6,9,10,12 • The upper and lower dentitions are bonded and banded, but no archwires are placed. This is to keep the upper and lower dentitions undisturbed and solid before surgery.…”

Section: Description Of the Surgery-first Conceptmentioning

confidence: 99%

“…An "interim transitional occlusion" is set up postsurgically in a correct molar relationship. 10 Intermaxillary fixation is removed 4 weeks postoperatively. Orthodontics is a postsurgical adjunctive therapy to transform this interim transitional occlusion into a solid final occlusion.…”

Section: Description Of the Surgery-first Conceptmentioning

confidence: 99%

“…The patient's chief complaint regarding facial esthetics is addressed and improved at the start of treatment. 10 The preparation is begun with fullmouth bonding and banding, but no orthodontic archwire is to be placed before surgery. Instead, insertion of surgical archwires with surgical hooks and wafer adjustment are performed a day before surgery.…”

Section: Description Of the Surgery-first Conceptmentioning

confidence: 99%

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Surgery-first Approach

Shah¹,

Deshmukh²,

Patil³

2017

World Journal of Dentistry

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Aim: This article is intended to provide an overview of the Surgery First Approach (SFA) mainly including case selection, diagnosis, treatment protocols, success rate and the potential problems encountered. Background:The most important indication of the need for orthognathic surgery is usually the psychosocial effect resulting from the unaesthetic appearance of a dentofacial deformity. The conventional approach in treatment of such deformities till today has been an orthodontics-first approach.

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“…12 Artificial bony implants are effective for bone augmentation; however, autologous bone grafts are still the first choice for many patients. 13 Three-dimensional printing techniques in conjunction with three-dimensional computed tomographic (CT) imaging have been used extensively for customizing bony implants. 14 In PHA patients with skeletal deformities, the accurate bone deficiency can be obtained by threedimensional CT scanning and mirror imaging.…”

mentioning

confidence: 99%

Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with 3D Planning and Printing

He¹,

Liu²,

Khatter³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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rogressive hemifacial atrophy (PHA) is also named Parry-Romberg syndrome, which was first reported by Parry in 1825 and established as a syndrome by Romberg in 1846. 1 It is an infrequent disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures in a hemifacial distribution. 2 This rare disorder usually begins in the first decade of life, and slowly progresses for 2 to 20 years before stabilizing. 3 The pathogenesis of PHA is not well understood. Trauma, infection, immune abnormality, cranial vascular malformation, and sympathetic dysfunction have all been implicated in this disease. 4 Although immunosuppressive treatment may slow down the progression of the disease, affected patients with obvious facial Background: Progressive hemifacial atrophy (PHA) is a rare disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures. For severe PHA patients with obvious bone deformities, skeletal framework reconstruction is needed in addition to soft-tissue augmentation. The authors propose a new combinatorial surgical method using rib cartilage graft and free adipofascial flap for restoring facial symmetry. To improve the surgical accuracy, preoperative three-dimensional planning and printing was used. Methods: Twelve patients with severe facial atrophy were included in the authors' study. Three-dimensional facial image analyses were performed preoperatively to quantify the facial asymmetry. Rib cartilages were harvested and sculptured to the appropriate shape created by three-dimensional planning and fixed to the atrophic bone. The circumflex scapular artery-based adipofascial flap was transplanted to repair soft-tissue deficiency. A residual small monitor flap was left with the adipofascial flap. A revision surgery was performed to perfect the repair if the contour was suboptimal 6 months postoperatively. Results: The adipofascial flaps survived in all 12 patients. All patients achieved good healing without complications. At 1 more year after surgery, the rib cartilage was still in position and rarely absorbed. The morphologic and volumetric difference between the affected side and the unaffected side was improved significantly postoperatively. All patients were satisfied with the results, and no more additional operations were required. Conclusion:The combinatorial surgery of rib cartilage graft and free adipofascial flap in the setting of three-dimensional planning and printing can be a good choice in restoring facial symmetry in severe cases of PHA.

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Skeleton First in Surgical Treatment of Facial Disharmony

Abstract: For most facial disharmony with or without occlusal dysfunction, skeleton-first surgery is a feasible strategy.

Cited by 5 publications

References 12 publications

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

Surgery-first Approach

Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with 3D Planning and Printing

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