Long-term skeletal and soft-tissue responses after advancement genioplasty.

INTRODUCTION: The objectives of this cephalometric study were to assess the skeletal stability of advancement genioplasty 3 years after surgery and to evaluate the predictability of soft-tissue changes. METHODS: The subjects comprised 21 consecutive patients who had no additional orthognathic surgical procedures. Lateral cephalograms were taken at 5 times: immediately preoperative, immediately postoperative, 6 months postoperative, and 1 and 3 years postoperative. RESULTS: Mean surgical advancement at pogonion was 8.4 mm. Three years after surgery, mean relapse at pogonion was 8% of the surgical advancement. Part of this change was most likely due to bone remodeling. No patient demonstrated a clinically significant postoperative change at pogonion. The soft tissue of the chin was found to follow bony movement in a ratio of 0.9:1. Great individual variability was observed. The mentolabial fold depth increased as a result of the treatment. Effects of advancement genioplasty on the lips were small. CONCLUSIONS: A prediction ratio based on long-term skeletal changes is likely to generate an estimate that is more appropriate to present to the patient.

Comparison of perioperative morbidity after LeFort III and monobloc distraction osteogenesis.

We have compared distraction by monobloc and LeFort III osteotomy in the treatment of midfacial retrusion. We treated 14 patients with midface distraction (Crouzon syndrome (n = 9), Apert disease (n = 3), and other (n = 2)), 7 of whom had monobloc distraction and 7 who had LeFort III osteotomy. We compared duration of operation, peroperative blood loss, and complications. The two groups were comparable with respect to diagnosis, type of distraction (internal or external device), and duration of distraction. The operating time was longer in the monobloc than in the LeFort III group, but not significantly so (p = 0.09). The weight-adjusted blood losses were significantly different (66 ml/kg and 34 ml/kg, respectively (p = 0.05). The two groups had similar numbers of complications (p = 0.3), and similar duration of hospital stay. Both techniques seem safe. The choice of operation, therefore, should be tailored to the individual patient and the monobloc procedure should be used if indicated.

A 3-year patient-centred follow-up of 516 consecutively treated orthognathic surgery patients.

The purpose of this study was to evaluate the outcome of a scheme for provision of orthognathic surgery by examining whether patients' expectations were fulfilled as well as their opinions about the result of treatment and side-effects. Data were obtained during a pre-planned 3-year follow-up clinical examination which included the administration of patient questionnaires. Of 583 subjects (281 females, 235 males; mean age 27.2 years) who underwent surgery during the period 1994-2002, 516 attended (89 per cent). Differences between subgroups and associations between variables were analysed by chi-square or Fisher's exact test. The most frequent motives for treatment were improvement of dental appearance and chewing ability, indicated by 83 and 81 per cent of the patients, respectively. The expectations were fulfilled for most patients, and satisfaction with the treatment result was reported by 92 per cent. Dissatisfaction was significantly related to gender, skeletal malocclusion, and surgical procedure (P = 0.001). Of all patients, 36.8 per cent reported impaired sensory function, the most frequent side effect. Sensory impairment and concern due to disturbed sensation were significantly related to age at surgery (P = 0.001 and P = 0.041, respectively). The treatment outcome as perceived by the patients was generally favourable. Even if sensory disturbance was frequently observed, most patients, especially in the younger age groups, seemed to adapt. Certain patient characteristics and surgical procedures were associated with an increased risk of dissatisfaction. These observations are relevant in the guidance of prospective orthognathic patients.

LeFort I maxillary advancement: 3-year stability and risk factors for relapse.

INTRODUCTION: The objectives of this retrospective cephalometric study were to assess the amount, direction, and timing of postoperative changes after LeFort I maxillary advancement, and to identify risk factors for skeletal relapse. METHODS: The material was selected from the files at the Department of Orthodontics, University of Oslo, and comprised 43 patients who underwent 1-piece LeFort I advancement as the only surgical procedure from 1990 to 1998. All patients were followed for 3 years by using a strict data collection protocol. Lateral cephalograms were obtained before surgery and at 5 times after surgery. RESULTS: A mean relapse of 18% of the surgical advancement occurred. In 14% of the patients, clinically significant skeletal relapse (> or = 2 mm) was observed. Most (89%) postoperative change occurred during the first 6 months after surgery. Skeletal relapse increased significantly with degree of surgical advancement (P = .001) and degree of inferior repositioning of the anterior maxilla (P = .004) (linear regression analysis). At the end of follow-up, overjet and overbite were within clinically acceptable ranges for all patients. CONCLUSIONS: Maxillary advancement with a 1-piece LeFort I osteotomy is a relatively stable procedure. Identified risk factors for horizontal relapse were degree of surgical advancement and degree of inferior repositioning of anterior maxilla.