Modified Intraoral C-Osteotomy.

ABSTRACT: Repeated sagittal split osteotomy might impose an increased risk for damage of the inferior alveolar nerve. Another contemporary orthognathic issue is surgical management of malocclusion following condylar resorption. Here we describe a modified C-osteotomy technique as a proposed solution for these difficulties in orthognathic surgery. The modified C-osteotomy might induce less stress on the condyles reducing the risk for relapse subsequent to condylar resorption, as well as reduce the risk of inferior alveolar nerve damage.

A Systematic Review to Uncover a Universal Protocol for Accuracy Assessment of 3-Dimensional Virtually Planned Orthognathic Surgery.

PURPOSE: The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. MATERIALS AND METHODS: A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. RESULTS: The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen κ test. CONCLUSIONS: On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.

Transoral Fixation of Bicortical Screws Is Safe and Feasible for Lower Jaw Osteotomies.

PURPOSE: Transoral placement of bicortical screws is a rigid fixation method in orthognathic surgery that is used less often than transbuccal placement. The aim of this study was to examine the postoperative outcome of transoral bicortical screw insertion during orthognathic surgery and to compare it with the more common transbuccal fixation technique. MATERIALS AND METHODS: A retrospective cohort study was conducted. Clinical files of orthognathic surgery patients operated on from January 2010 through December 2012 were reviewed. Screw insertion approach (transoral vs transbuccal) was examined as a predictive variable for postoperative complications (hardware removal and infection). Type of surgery, fibrin sealant, preoperative third molar removal, and patient age and gender were analyzed as potential risk factors. Descriptive and bivariate statistics and regression analyses were performed. RESULTS: Of the 606 patients whose cases were reviewed, 509 patients (185 men; mean age, 26.3 ± 11.1 yr) met the inclusion criteria. Most presented with a Class II malocclusion (84.5%). A transbuccal approach was used in 27.5% of cases, leading to a screw-related infection of 6.3%. Patients treated with a transoral technique (72.5%) had fewer infections (3.5%), but this was not statistically relevant. Screw removal was indicated in 3.3% of patients. Screw placement using the transoral and transbuccal approaches was performed in 3.0 and 4.2% of patients, respectively. Infection and screw removal rates did not differ significantly between fixation techniques (P = .16 and P = .49, respectively). CONCLUSION: The present findings showed an overall low rate of screw removal and infection secondary to bicortical screw insertion during orthognathic surgery. The postoperative outcome was similar for the transoral and transbuccal approaches.

Plate removal following orthognathic surgery.

OBJECTIVES: The objectives of this study were to analyze outcomes with miniplates in orthognathic surgery and define risk factors resulting in plate removal. STUDY DESIGN: Clinical files of 570 orthognathic surgery patients operated between 2004 and 2009 were reviewed: 203 had a bimaxillary operation, 310 a lower jaw osteotomy, and 57 an upper jaw osteotomy. Age, sex, and jaw movement were analyzed. Reasons for hardware removal were recorded. RESULTS: Hardware was removed in 157 patients (27.5%). Seventy-eight patients (13.7%) needed removal because of plate-related infection; 66 (11.6%) because of clinical irritation; 5 (0.9%) for dental implant placement; and 8 (1.4%) for other reasons. Average time between operation and removal was 9.9 months. More women (31.7%) than men (20.3%) had plates removed, but age was not a factor except with infection. CONCLUSIONS: More than a quarter of patients developed complications from plates and screws, necessitating their removal, and infection occurred in 13.7%. Prompt removal constituted adequate management.

The use of a Kirschner wire in the treatment of a comminuted le fort I fracture: a case report.

Simultaneous fracture of the maxilla and cervical vertebrae rarely occurs in bicycling accidents. The following case report describes a simple technique for closed reduction of a severely comminuted maxillary fracture with shattering of the dentoalveolar process. The combination of a rigid external distractor halo frame on the skull, a Kirschner wire through the maxilla, and an intermaxillary wire fixation resulted in stable vertical and sagittal correction of the fragmented maxilla with adequate access and minimal manipulation and without necessitating removal of the cervical collar.

Occurrence of bad splits during sagittal split osteotomy.

OBJECTIVES: The objectives of this study were to determine the incidence of bad splits in sagittal split osteotomies (SSOs), performed at the same hospital, and if the occurrence was reduced over time because of technical progress and/or surgical experience. Bad splits were defined as buccal or lingual plate fractures. STUDY DESIGN: The files of all patients (n = 1008) who underwent bilateral or unilateral SSO between October 1989 and October 2009 were reviewed retrospectively. RESULTS: A bad split occurred in 14 SSO sites (14 of 2005 sites). No bilateral bad splits occurred. There was no notable decrease of bad splits over the 20 years. All bad splits were resolved perioperatively by plate-osteosynthesis without the additional need of intermaxillary fixation. All patients with a bad split had a good and functional occlusion 6 months postoperatively. No infections occurred at the site of the bad splits. No bad splits occurred in patients younger than 20 years. No particular type of dental-facial deformity, or skeletal class according to the Angle's classification could be correlated with cases of bad splits as a predisposing risk factor. CONCLUSION: Even if precautions are taken, a bad split can occur during SSO of the mandible. This complication is manageable because of its low incidence (0.7 % of all SSOs) and uneventful healing. A significant decrease in incidence did not occur during the 20-year period, and neither technical progress nor the surgeon's experience further reduced the incidence of bad splits.