Differential outcomes of jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients.

BACKGROUND/PURPOSE: Facial asymmetry is common in Class III patients requiring orthognathic surgery. This study aimed to analyze jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. METHODS: The retrospective study included 30 Class III patients who underwent surgical-orthodontic treatment comprising LeFort I osteotomy and bilateral sagittal split osteotomy (BSSO) without genioplasty. Cone-beam computed tomography (CBCT) images obtained before surgery (T1) and after post-surgical orthodontic treatment (T2) were superimposed with voxel-based registration. Patients were classified into three groups based on T1 CBCT scans. Groups 1 and 2 exhibited menton and ramus deviated to the same side. Menton deviation was larger than ramus width asymmetry in group 1, while the reverse was true for group 2. Group 3 had menton deviation contralateral to the side with greater ramus width. RESULTS: Menton deviation after treatment was improved in all groups. Ramus width asymmetry and coronal ramus angle difference decreased in groups 1 and 2. Neither improvement nor deterioration of ramus width asymmetry was noted for group 3. Comparing to groups 1 and 2, group 3 had greater roll and yaw rotations of distal segment, more upward pitch of proximal segment on chin deviation side, and largest inward yaw as well as backward translation of proximal segment on non-deviation side. CONCLUSION: The positional changes of osteotomy segments differed among three types of mandibular asymmetry. Special attention should be given to the atypical mandibular asymmetry with mandibular body and ramus deviating to opposite directions during surgical correction of jaw deflection.

Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study.

The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T0), one month (T1), and 6 months (T2) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T0 to T1 (p = 0.003), followed by an increase from T1 to T2 (p = 0.040). PPD (T0 = 1.72 ± 0.46; T2 = 2.13 ± 0.43) and CAL (T0 = 1.24 ± 0.55; T2 = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T0, T1 and T2. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.

Determining Morbidity of Adding Genioplasty to Bimaxillary Orthognathic Surgery.

BACKGROUND: Patients with dentofacial anomalies may undergo orthognathic surgery to address functional and aesthetic concerns. Past works have evaluated determinants affecting length of stay (LOS) in patients undergoing upper and/or lower jaw surgery alone. No studies have assessed the addition of genioplasty to double-jaw (Lefort I, bilateral sagittal split osteotomy (BSSO))) surgery and its effect on LOS and other outcomes. This study investigates whether the addition of genioplasty incurs additional morbidity to patients undergoing complex orthognathic surgery. METHODS: This was a retrospective cohort study of patients undergoing orthognathic surgery at Yale-New Haven Hospital. Clinical and demographic information were compared across the "double"- and "triple"-jaw cohorts with t tests and Chi-squared analyses. Multivariable linear and logistic regression analyses were utilized to assess the impact of genioplasty when controlling for baseline patient differences. RESULTS: A total of 27 patients received Lefort I and BSSO (double-jaw), and 224 received Lefort I, BSSO, and genioplasty (triple-jaw). Six (22.2%) double-jaw patients were segmental and fifty-eight (25.9%) triple-jaw patients were segmental (p > 0.05), during the study period. Triple-jaw surgery was associated with increased operative time (+ 41.1 min, p < 0.01). There was no increase in LOS, postoperative nausea and vomiting, opioid use, hematoma, or infection (p > 0.05). CONCLUSIONS: This study attempted to determine if triple-jaw surgery could influence patients' LOS and other surgical outcomes compared to double-jaw surgery. Only the operative time was significantly affected. This indicates that incorporation of a genioplasty can provide aesthetic benefit without incurring significant additional morbidity to the patient. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of Severe Skeletal Class II High Angle with Mandibular Retrusion and Gummy Smile by Double-Jaw Surgery.

This report describes the treatment of severe skeletal Class II malocclusion in a young woman with a gummy smile and pronounced lower anterior facial height. Overjet and overbite were +12.0 mm and -1.0 mm, respectively. Cephalometric analysis revealed inferior positioning of the maxilla and severe mandibular retrusion with clockwise rotation. Both the upper and lower anterior teeth showed labial inclination. Based on a diagnosis of a skeletal Class II high angle with mandibular retrusion and a gummy smile, double-jaw orthognathic surgeries for upper and lower premolar extraction were chosen to gain ideal occlusion and an improvement in the esthetic facial profile. Le Fort I osteotomy was performed to move the anterior and posterior teeth upward by 4.0 mm and achieve mandibular counterclockwise rotation. Short lingual sagittal split ramus osteotomy was performed to move the mandible forward by 3.0 mm. As a result, normal overjet and overbite were achieved together with a straight profile and a good smile. After surgery, electromyographic evaluation of anterior temporal muscle activity showed an improvement in the percentage overlapping coefficient value (a symmetric index of bilateral muscle activity) from 28.1% to 63.2% compared to at pre-treatment. The pattern of jaw movement also showed an improvement. These results suggest that orthognathic surgery in skeletal Class II cases can improve not only malocclusion and the skeletal relationship of the jaws, but also masticatory function and jaw movement.

Comparative Study of Morphology and Distribution of Valves in Human Retromandibular Vein.

The objective of this study was to analyze the distribution and morphology of the valves in the human retromandibular vein. The retromandibular, internal thoracic, azygos, femoral, and brachial veins were harvested from 46 cadavers donated to the Department of Anatomy at Tokyo Dental College for dissection. The frequency of the valves in each vein, the length of the cusps, and the thickness of the vein itself were measured. Valves were present at high frequency (92.1%) in the veins of the limbs and had cusps at least twice as long as the internal diameter of the vein. Veins in the trunk contained a lower frequency of valves, with cusps that tended to be shorter (1.60±0.77) than those of the venous valves in the limbs (2.12±0.60). The valves of the retromandibular vein tended to resemble venous valves in the trunk in terms of both frequency and morphology. The main function of venous valves in the limbs is to prevent retrograde flow. Conversely, valves in the veins of the trunk and retromandibular vein play a role in retaining blood in the veins, and their relationship to other veins means that they can cause major hemorrhage.

Treatment efficiency and stability of skeletal Class III malocclusion with a surgery-first approach.

OBJECTIVES: To compare treatment duration in skeletal Class III malocclusion patients managed with a 2-step treatment (surgery-first approach, SFA) and conventional 3-step treatment, and to compare stability of surgical outcomes between segmentation and non-segmentation in the 2-step treatment group. SETTING AND SAMPLE POPULATION: The sample population consisted of 37 patients who completed orthognathic surgery (OGS) and orthodontic correction at the Charm Aesthetic Surgery Clinic (Taipei, Taiwan) between 2012 and 2015. Of these, 26 received 2-step treatment and 11 received 3-step treatment. MATERIALS AND METHODS: To compare treatment efficiency and stability, three time points were analysed: T0 , before treatment (before OGS in the 2-step group and before orthodontic treatment in the 3-step group); T1 , after OGS but before orthodontic correction (cone beam computed tomography (CBCT) was obtained within 2 weeks of OGS); and T2 , after orthodontic correction (CBCT was obtained on the day of bracket removal). The post-OGS (T1 ) CBCT items were individually superimposed on the pre-treatment (T0 ) CBCT items to determine the distance of B point migration. RESULTS: A significant difference was found in treatment times between 2-step treatment and conventional 3-step treatment. In addition, no significant difference was found when comparing B-X (mm) and B-Y (mm) at T2 -T1 for the segmentation and non-segmentation groups. CONCLUSIONS: Using SFA for skeletal Class III malocclusions saves approximately 6 months of treatment time over 3-step treatment; the stability of the segmentation group was comparable to that of the non-segmentation group, a result that is possibly associated with the fixation of 2 miniplates.

Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper.

OBJECTIVES: A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery. SETTING AND SAMPLE POPULATION: The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion. MATERIAL AND METHODS: A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study. RESULTS: Current recruitment of patients is on track to complete the study within the proposed recruitment period. CONCLUSION: This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.

Tongue pressure production during swallowing in patients with mandibular prognathism.

UNLABELLED: Abnormalities of swallowing in patients with mandibular prognathism have not been evaluated quantitatively. The aim of this study was to compare tongue pressure production for bolus transfer between volunteers with normal occlusion and patients with mandibular prognathism. The control group had 10 female volunteers with normal occlusion, and the patient group had 10 women with mandibular prognathism. Tongue pressure was measured by a palatal sensor sheet at five sites on swallowing 4 mL of a tasteless and odourless jelly. RESULTS: The tongue pressure waveform differed between the control and patient groups. The incidence of a double-peak tongue pressure waveform was more frequent in the patient group. In both groups, the exertion of tongue pressure began at the anterior point of the sensor sheet, followed by the peripheral parts. Although the order of expression of tongue pressure was the same for the two groups, maximum tongue pressure at all parts of the sensor sheet was lower in the patient group than in the control group. Furthermore, swallowing time was longer in the patient group than in the control group at the peripheral parts of the palate. These results clearly show the difference in tongue pressure production during swallowing between patients with mandibular prognathism and volunteers with normal occlusion. The current findings suggest that maxillofacial morphology may affect tongue movement during swallowing.

Asymmetric Anterior Distraction for Transversely Distorted Maxilla and Midfacial Anteroposterior Deficiency in a Patient With Cleft Lip/Palate: Two-Stage Surgical Approach.

The present report describes a male patient with a unilateral cleft lip and palate who presented with midfacial anteroposterior and transverse deficiency. Correction involved a two-stage surgical-orthodontic approach: asymmetric anterior distraction of the segmented maxilla followed by two-jaw surgery (LeFort I and bilateral sagittal splitting ramus osteotomies). The present case demonstrates that the asymmetric elongation of the maxilla with anterior distraction is an effective way to correct a transversely distorted alveolar form and midfacial anteroposterior deficiency. Furthermore, successful tooth movement was demonstrated in the new bone created by distraction.

Comparison between one-jaw and two-jaw designs in virtual surgery planning for patients with class III malocclusion.

Orthognathic surgery is highly effective for treating maxillomandibular discrepancies in patients with class III malocclusion. However, whether one- or two-jaw surgery should be selected remains controversial. Our study aimed to evaluate quantitative differences between one-jaw and two-jaw surgical designs. In total, 100 consecutive patients with skeletal class III malocclusion who underwent orthognathic surgery with preoperative three-dimensional simulation between August 2016 and November 2021 were recruited. Based on the same final occlusal setup, a two-jaw surgery design and two types of one-jaw design were created. In total, 400 image sets, including preoperative images and three types of surgical simulation, were measured and compared. The one-jaw mandibular setback design led to improvement in most cephalometric measurements and facial symmetry. Although the one-jaw maxillary advancement design improved the ANB angle and facial convexity, it induced maxillary protrusion and reduced facial symmetry. Compared with the other designs, the two-jaw design provided significantly closer cephalometric measurements to the normative values, better symmetry, and less occlusal cant. Overall, the two-jaw design provided a quantitatively better facial appearance in terms of symmetry, proportion, and profile. Although an optimal surgical design necessitates thorough preoperative evaluation and a shared decision-making process, two-jaw surgery can be considered for improving overall facial esthetics and harmony.

Can a unilateral total temporomandibular joint prosthesis affect the healthy contralateral temporomandibular joint? A systematic review.

Temporomandibular joint (TMJ) prostheses are considered an important alternative for the treatment of severe end-stage TMJ disorders. However, unilateral TMJ replacement may affect the healthy contralateral TMJ. The purpose of this study was to systematically review the literature on the effects of unilateral total TMJ prosthesis placement on the contralateral healthy TMJ. The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched for English-language articles published up to December 2023. Inclusion criteria encompassed clinical studies (randomized, prospective, retrospective, observational) that evaluated clinical and patient-reported outcomes after total unilateral TMJ prosthesis placement (both glenoid and mandibular components). The initial search identified 141 non-duplicate studies, of which eight remained after title and abstract reading. Four studies included only unilateral prostheses; the other four included bilateral interventions and/or control groups without any TMJ intervention. The studies reported on stock and custom prostheses, with custom prostheses being the most used. As the studies had different specific objectives, no pattern of data reporting was found and the research question could not be answered. Randomized clinical trials with standardized variables are required to achieve reliable conclusions. Furthermore, long-term follow-up is necessary to determine whether the function of the healthy TMJ is compromised.

Changes in the lip-line in asymmetrical cases treated with isolated mandibular surgery.

OBJECTIVE: The aim of this study was to investigate changes in the lip-line in asymmetrical cases treated with mandibular osteotomy alone. DESIGN: Retrospective study. SETTING: Hiroshima University Institute of Biomedical & Health Sciences, Hiroshima, Japan METHODS: The subjects in this study consisted of 30 patients with an altered lip-line inclination who underwent isolated mandibular osteotomy (bilateral or unilateral sagittal split ramus osteotomy or intraoral vertical ramus osteotomy) as part of their surgical correction. Frontal cephalograms and facial photographs, taken at the first examination and after treatment, were used to measure changes in the inclination of the lip-line and cant of the occlusal plane, as well as the lateral deviations of hard and soft tissue Menton. RESULTS: Inclination of the lip-line after active treatment was significantly improved compared with that before treatment. Menton on the hard and soft tissues after active treatment also experienced a significant improvement compared with its position at first examination. CONCLUSIONS: One-jaw mandibular osteotomy is able to improve the inclination of the lip-line even in the presence of an occlusal cant. The inclination of the lip-line is corrected in association with sufficient lateral movements of Menton on the mandible.

A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients.

Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety.

A retrospective analysis of redo orthognathic surgery: Underlying causes, strategy, and outcome.

The aim of this study was to investigate the underlying causes of the need for redo orthognathic surgery, address surgical strategies, and evaluate postoperative outcomes. A retrospective chart review was conducted involving patients who underwent redo orthognathic surgery between January 2018 and April 2020. A total of 32 patients were included in this study. Prior to the procedures, patients' chief complaints were unfavorable facial profile, asymmetry, relapse, malocclusion, obstructive sleep apnea, and long face. To address these issues, we performed redo orthognathic surgery: this resulted in satisfactory aesthetic and functional outcomes in most cases. Considering the challenging nature of a redo orthognathic surgery, it is crucial for surgeons to accurately evaluate the patient's chief complaints and tailor individualized surgical plans to meet the patient's expectations.

Does YouTube offer high-quality information? Evaluation of patient experience videos after orthognathic surgery.

OBJECTIVES: To evaluate the content, reliability, and quality of videos of patient experiences after orthognathic surgery on YouTube. MATERIALS AND METHODS: Fifty videos that met the inclusion criteria were analyzed. The demographic characteristics of the videos were determined, and 13 points were used to classify poor and rich-content videos. The quality of the videos was evaluated using the Video Information and Quality Index (VIQI), Global Quality Score (GQS), and DISCERN. The Mann-Whitney U-test, Spearman correlation, and linear regression analysis were used for statistical analysis. RESULTS: When poor- and rich-content videos were evaluated, there were statistically significant differences in video duration, number of likes, number of comments, and interaction index (P < .05). Compared to the poor-content video group, the GQS score, DISCERN, total content, and VIQI score of the rich-content video group were significantly higher. The interaction index and video duration and video information content quality showed a positive relationship. CONCLUSIONS: Although the quality of the videos shared by patients on YouTube was generally moderate, the content of the information was generally poor. Nevertheless, it should be considered that YouTube videos can be a source of information for patients who want to have surgery, which can affect the process.

Does Social Media Affect a Patient's Decision to Undergo Orthognathic Surgery?

Orthognathic surgery, also known as corrective jaw surgery, is a procedure that corrects abnormalities of the jaw and face. It is used to treat malocclusions, where the teeth and jaws are misaligned. This surgery can improve the function and appearance of the jaw and face, leading to improved mastication, speech, and quality of life for the patients. To assess if social media had any effect on the patients' decision to undergo orthognathic surgery, a self-administered online questionnaire was distributed to patients who had undergone orthognathic surgery at the Oral and Maxillofacial department through the health information system (BESTCare, 2.0A) to participate in the study. In total, 111 responses were recorded from the patients, with 107 agreeing to answer the questionnaire and 4 refusing to answer. Twitter was a source of information about orthognathic surgery for 61 patients (57%). When using a social media platform, 3 patients (2.8%) were influenced by an advertisement or an educational post on social media that presented the surgical correction of the jaws, while 15 (14%) believed that they had been somewhat influenced, and 25 (23.4%) picked their surgeon through social media. Fifty-six patients (52.3%) took the neutral position regarding whether information on social media had answered their questions and concerns regarding the surgical procedure. Social media did not influence patients' decision to undergo the procedure. Surgeons and specialists must utilize their platforms to answer any concerns or questions from any patient undergoing or having undergone this corrective jaw surgery.

Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery.

PURPOSE: The aim of this study was to assess the accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. MATERIALS AND METHODS: A total of 73 patients undergoing single-piece LeFort I osteotomies in the maxilla and bilateral sagittal split osteotomies in the mandible were included in the study. Preoperative and immediate postoperative cone-beam CT were compared in computer software (Dolphin3D©). Maxillary landmarks relative to the vertical and horizontal reference lines were evaluated. The difference between the planned and achieved maxillary positions was measured. Distance error in millimeters and achievement ratio (achieved displacement/planned displacement*100) were calculated for different maxillary movements. RESULTS: Midline correction and advancement were the most accurate movements with an overall mean distance error of 0.53 mm and 0.63 mm respectively while posterior impaction and setback were the least accurate movements with 1.38 mm and 1.76 mm mean discrepancies, respectively. A significant difference was observed only in setback movement regarding the discrepancy value (P < .05). Although setback and down-graft movements tended to under-correction, all other movements were overcorrected. As the magnitude of maxillary movements increases, the accuracy decreases. In severe displacements (≥ 8 mm), the accuracy declines significantly (P < .05). CONCLUSION: Classic cast surgery and manually fabricated intermediate splints in teaching hospitals yield accurate and acceptable results in the majority of cases (84.6%). The accuracy of maxillary repositioning decreases as the magnitude of displacement increases.

Assessment of soft- and hard-tissue changes following combined anterior segmental bi-jaw orthognathic surgery.

Background: Anterior segmental Bi-jaw orthognathic surgery is indicated primarily for the correction of dentoalveolar protrusion. They are also indicated for correcting apertognathia, closing interproximal spaces between segments and can be incorporated with other osteotomies to obtain better results. Aim: The aim of this study was to analyze and compare the soft- and hard-tissue changes in patients who underwent combined anterior segmental bi-jaw orthognathic surgery. Settings and Design: To compare and evaluate soft- and hard-tissue changes before and after combined anterior segmental bi-jaw orthognathic surgery by assessing (a) parameters in vertical dimension and (b) parameters in horizontal dimension and patient satisfaction was also assessed following surgery at 6 months' time interval. Materials and Methods: It is a prospective, single center and analytical study with sample size of 20 patients. It required routine setup for orthognathic surgery and manual tracing of lateral cephalograms. The surgical outcomes were assessed by hard tissue (Sella Nasion Point A (SNA) angle, Sella Nasion Point B (SNB) angle, Point A Nasion Point B (ANB) angle, NAPg, U1-NF, L1-MP angles; NA, NB, B-Pg, Nasion-Anterior nasal spine (N-ANS) distance, Anterior nasal spine-Gnathion (ANS-Gn) distance, and overjet and overbite) and soft tissue (facial convexity, NL, LM angles; LM fold, UL and LL protrusions, Upper lip length (ULL), Lower lip length (LLL), Sn-A, Si-B, Pg-Pg*, Ls-U1, Li-L1 distances, interlabial gap, and U1 exposure) variables pre and postsurgery. Statistical Analysis: Descriptive statistics involved the mean and standard deviation, and recorded data were subjected to the statistical analysis using IBM SPSS 20 statistical package. The paired t-test, Pearson correlation coefficient were used. The level of significance P < 0.05 was taken as statistically significant and P < 0.01 as very significant. Results: Overall improvement after surgery in both hard- and soft-tissue parameters was observed and significant changes were seen in every variable, except Si-B (P > 0.05). Correlations between soft- and hard-tissue changes were significant in both sagittal and vertical planes. Patients' satisfaction score showed that all patients had the high overall rate of satisfaction. Conclusions: Our study concludes that combined anterior segmental bimaxillary orthognathic surgery is a simple technique with minimal postoperative complications and limited relapse. The changes in facial esthetics and occlusion following orthognathic surgery depend highly on the stability achieved during the postoperative period.

Rehabilitation of severe dentofacial deformity after early radiotherapy of retinoblastoma: a case report.

BACKGROUND: Retinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia. CASE PRESENTATION: We present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained. CONCLUSION: In an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical-orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.

Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery-a 10-year retrospective study.

PURPOSE: To retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications. METHODS: The electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed. RESULTS: Two hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group. CONCLUSION: The HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior-posterior transpositions of the mandible.