Three-Dimensional Computer-Assisted Single-Splint 2-Jaw Cleft Orthognathic Surgery: Toward Patient-Centered Surgical Rationale

Denadai, Rafael; Chen, Yu-Ray; Lo, Lun-Jou

doi:10.1177/1055665620949113

Cited by 17 publications

(6 citation statements)

References 24 publications

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“…two-jaw surgery. 25,26 In patients who had previously ungrafted or poorly grafted alveolar clefts, maximal cleft approximation for alveolar repair can be combined at the time of OGS. The surgery-first approach provides several positive aspects: immediate improvement of facial appearance rather than worsening before surgery; reduced total treatment time by eliminating the presurgical orthodontic stage and facilitating tooth movement 3 to 4 months after surgery by regional acceleratory phenomenon [27][28][29][30] ; and easier orthodontic tooth movement after surgical correction of the skeletal discrepancy because the direction of tooth movement for decompensation is not against the soft-tissue pressure.…”

Section: Discussionmentioning

confidence: 99%

“…21–24 A protrusive mandible is also common in our population without clefts; thus, to provide favorable facial profile and symmetry, cleft OGS at our center has evolved to the current patient-centered approach focusing on dentofacial reconstruction using two-jaw surgery. 25,26 In patients who had previously ungrafted or poorly grafted alveolar clefts, maximal cleft approximation for alveolar repair can be combined at the time of OGS.…”

Section: Discussionmentioning

confidence: 99%

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Surgery-first orthognathic approach for correction of dentofacial deformity in unilateral cleft lip and palate

Liao¹,

Chen²,

Chang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. Methods: Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. Results: A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. Conclusion: These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgery-first orthognathic approach for correction of dentofacial deformity in unilateral cleft lip and palate

Liao¹,

Chen²,

Chang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…The E line and lower face proportions (specifically, one-third and two-thirds for distances from subnasale to lip and from intercommissural plane to chin point, respectively) were also evaluated to determine the need for genioplasty. This intraoperative patient-specific assessment ensured that not only dental occlusion status (eg, mouth opening, biting, and chewing parameters) but also facial appearance concepts (eg, proportion, harmony, and symmetry) were taken into consideration during the surgical procedure 9,16,36,37 …”

Section: Methodsmentioning

confidence: 99%

“…This intraoperative patient-specific assessment ensured that not only dental occlusion status (eg, mouth opening, biting, and chewing parameters) but also facial appearance concepts (eg, proportion, harmony, and symmetry) were taken into consideration during the surgical procedure. 9,16,36,37 Postoperative Care Intermaxillary fixation was not applied, and patients were hospitalized in a standard ward for a duration of 2 days. Following discharge, they underwent regular clinical evaluations during scheduled surgical and orthodontic appointments.…”

Section: Surgical Techniquementioning

confidence: 99%

Single-Splint, 2-Jaw Orthognathic Surgery for Correction of Facial Asymmetry: 3-Dimensional Planning and Surgical Execution

Sato,

Denadai,

Hung

et al. 2023

Journal of Craniofacial Surgery

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Three-dimensional (3D) planning of orthognathic surgery (OGS) improves the treatment of facial asymmetry and malocclusion, but no consensus exists among clinicians regarding technical details. This study verified the consistency of authors’ workflow and strategies between 3D planning and surgical execution for facial asymmetry. This retrospective study recruited consecutive patients (n=54) with nonsyndromic facial asymmetry associated with malocclusion. The stepwise workflow included orthodontic treatment, 3D imaging-based evaluation, planning, and transferring the virtual of single-splint 2-jaw OGS to actual surgery in all patients. Seven landmark-based measurements were selected for postoperative assessment of facial symmetry. Fifty patients had no anesthetic/surgical-related episode and procedure-related complications. Others experienced wound infection (n=1), transient TMJ discomfort (n=1), and facial numbness (n=3). Two cases had minor residual asymmetry (cheek and chin, respectively), but did not request revisionary bone or soft tissue surgery. Comparisons between the planned and postoperative 3D images with quantitative measurement revealed acceptable outcome data. The results showed a significant increase in facial symmetry at 7 landmark-based postoperative measurements for both male and female. This 3D-assisted pathway of OGS permitted achievement of consistent satisfactory results in managing facial asymmetry, with low rate of complications and secondary management.

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“…Orthognathic surgery has been proved highly effective in the treatment of a wide spectrum of maxillofacial deformities. 1–5 It helps to improve facial aesthetics, achieve a harmonious facial profile, and attain an ideal occlusion. Despite being uncommon, facial nerve injury is one of the most serious complications after orthognathic surgery.…”

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confidence: 99%

Facial palsy after orthognathic surgery: Incidence, causative mechanism, management, and outcome

Hattori¹,

Huang²,

Chang³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be underreported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome. Methods: A retrospective review of orthognathic surgery records between January of 1981 and May of 2022 was conducted in the authors' craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiologic images, and photographs were collected. Results: A total of 20,953 sagittal split ramus osteotomies (SSROs) were performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, the Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than the Hunsuck technique using the manual twist splitting (P < 0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median duration of 3 months [interquartile range (IQR), 2.75 to 6 months] after surgery, whereas 11.1% attained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster median recovery (3 months; IQR, 2 to 3 months) than the complete palsy patients (6 months; IQR, 4 to 6.25 months) (P = 0.02). Conclusions: The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated.

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Three-Dimensional Computer-Assisted Single-Splint 2-Jaw Cleft Orthognathic Surgery: Toward Patient-Centered Surgical Rationale

Cited by 17 publications

References 24 publications

Surgery-first orthognathic approach for correction of dentofacial deformity in unilateral cleft lip and palate

Surgery-first orthognathic approach for correction of dentofacial deformity in unilateral cleft lip and palate

Single-Splint, 2-Jaw Orthognathic Surgery for Correction of Facial Asymmetry: 3-Dimensional Planning and Surgical Execution

Facial palsy after orthognathic surgery: Incidence, causative mechanism, management, and outcome

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