Morphological Changes of the Temporomandibular Joint and Masseter Muscle After Mandibular Angle Osteotomy.

Mandibular angle osteotomy with outer cortex grinding is an effective cosmetic procedure for correcting square faces. However, morphological changes in the mandible may also cause temporomandibular joint (TMJ) disorders. This retrospective study aimed to investigate the morphological stabilization of the TMJ and changes in masseter muscle thickness after mandibular angle osteotomy to evaluate the safety of the procedure. Data from patients who underwent mandibular angle osteotomy with outer cortex grinding between January 2016 and January 2019 were retrospectively reviewed. Preoperative and long-term follow-up (~1 y) computed tomography data were collected from these patients, and morphological changes in the TMJ and masseter muscle were analyzed. The results from the computed tomography data showed that the condylar length and condylar height were significantly reduced 1 year after the operation (P < 0.05). In addition, the morphology of the TMJ was stable, and the distance between the mandibular condyle and the glenoid fossa did not change significantly. No significant difference was observed in masseter muscle thickness before and after the operation. After mandibular angle osteotomy with outer cortex grinding, the length and height of the mandibular condyle were functionally restored without any disorders of the TMJ. Moreover, the masseter muscle exhibited stable function. In conclusion, the procedure is safe for occlusal function and suitable for popularization.

Global Research Trends and Focuses on Pierre Robin Sequence From 1992 to 2023: A Bibliometric Analysis of the Past 3 Decades.

There is currently a lack of scientific bibliometric analyses in the field of Pierre Robin sequence (PRS). Pierre Robin sequence is known for its clinical triad of micrognathia, glossoptosis, airway obstruction, and possible secondary cleft palate. These defects can lead to upper airway obstruction, sleep apnea, feeding difficulties, affect an individual's growth and development, education level, and in severe cases can be life-threatening. Through analysis of literature retrieved from the Web of Science Core Collection (WoSCC) database using Results Analysis and Citation Report and Citespace software, 933 original articles and reviews were included after manual screening. The overall trend for the number of annual publications and citations was increasing. On the basis of the analysis, airway evaluation and treatment, mandibular distraction osteogenesis (MDO), as well as descriptions of PRS characteristics have been the focus of research in this field. In addition, with advances in new technologies such as gene sequencing and expanding understanding of diseases among researchers, research on genetics and etiology related to PRS has become a growing trend.

Craniofacial and Upper Airway Development in Patients With Treacher Collins Syndrome.

ABSTRACT: This study evaluated age-associated morphology changes in the cranial base, facial development, and upper airway of patients with Treacher Collins syndrome (TCS). A total of 33 preoperative computed tomographic images (TCS, n = 14; control, n = 19) were included in the study and divided into three age-related subgroups (2-6 years, 7-18 years, and older than 18 years). Linear, angular cephalometric measurements and upper airway volumes were collected. All measurements were analyzed using ProPlan CMF software (version 3.0; Materialize, Leuven, Belgium). The association between aging and upper airway morphology was analyzed. Compared to control subjects, TCS patients had a smaller cranial base, maxilla, and nose; they also had reduced upper airway volume compared to control subjects. The observed differences were most significant in patients between the ages of 7 and 18 years. This study used computed tomography-based three-dimensional analyses to provide a detailed description of age-related changes that occur in craniofacial measurements and upper airway volumes in children, adolescents, and young adult patients with TCS in China. These data can be used to evaluate individual patients with TCS and to select treatment to improve the growth of the craniofacial region.

Application of the Bracing System in Reduction Malarplasty in Asian Population.

BACKGROUND: In the East, a broad and prominent malar is considered to express an aggressive and unpleasing impression; therefore, patients seek to improve their appearance through malar reduction. Although most of the techniques have been greatly improved, still there are some pitfalls in the form of cheek sagging or bone nonunion. In this study, we performed a reduction malarplasty using a firm bracing system to minimize major postoperative complications. METHOD: This was a retrospective study evaluating the results of a total of 157 patients (139 women and 18 men) who underwent reduction malarplasty using a bracing system via intraoral and periauricular. The age of the patients ranged from 17 to 44 with a mean age of 25.3 years. The mean follow-up period was 9.4 months. All patients underwent routine physical and laboratory examinations. Facial photographs in the frontal, oblique, and submentovertical views were taken. Patients with severe facial asymmetry and facial deformities were excluded from the study. Preoperative states and patients' desires were considered. In some patients, combined malarplasty with mandibular angle reduction or genioplasty was performed. RESULTS: A total of 157 patients who underwent this modified reduction malarplasty between January 2015 and January 2019 were retrospectively reviewed. Decent postoperative facial stability and satisfactory aesthetic results were realized among all patients. Major complications such as severe asymmetry or bone nonunion were not observed in our patients. CONCLUSION: Based on a thorough anatomic understanding of zygoma and masseter action, we modified previous L-shaped reduction malarplasty through constructing a firm bracing system on the malar complex. Satisfactory surgical outcomes were obtained. Our method is an ideal surgical method to effectively reduce the height and width of the zygomatic arch and prevent complications such as bone nonunion and cheek drooping. LEVEL OF EVIDENCE IV: 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.

Correlation Between Mandible and External Ear in Patients with Treacher-Collins Syndrome.

BACKGROUND: Patients with Treacher-Collins syndrome (TCS) are frequently affected by congenital ear deformities. The external ear in patients with TCS tends to have both abnormal morphology and reduced overall volume. Previous studies considered a correlation exists between TCS mandibular skeletal features and external ear volume. The purpose of this study was to assess the external ear volume in patients with TCS 3-dimensionally. Furthermore, this study evaluated the relationship between mandibular morphology, external ear profile, and external ear volume. METHODS: A total of 36 nonoperated patients with TCS were compared to 39 age- and gender-matched normal controls. Morphologic variables of the mandible and the external ear were compared between TCS group and controls by 3-dimensional cephalometrics. The external ear volume and morphologic variables were analyzed with independent sample T-tests and Pearson correlation coefficient analyses (level of evidence: level III). RESULTS: The external ear volume was reduced by approximately 50% in patients with TCS compared to controls (P < 0.001). External ear length and width were positively correlated with external ear volume (length: r = 0.809, P < 0.001 on left and r = 0.732, P < 0.001 on right; width: r = 0.518, P = 0.001 on left and r = 0.447, P < 0.010 on right). A negative correlation of right ear inclination angle and external ear volume was shown in patients with TCS (r = -0.396, P = 0.027). However, no correlation was shown for the mandibular anatomic variables. CONCLUSIONS: Three-dimensional analysis confirmed that external ear volume is significantly reduced in patients with TCS. The external ear dimensions and orientation correlated significantly with ear volume. There was no intrinsic association between the severity of mandibular deformity and external ear volume.

Prevalence of Different Forms and Involved Bones of Craniofacial Fibrous Dysplasia.

BACKGROUND: The purposes of this study were to analyze the prevalence of various craniofacial bones involved in patients with craniofacial fibrous dysplasia (CFD) and to demonstrate the most common form and bone involvement in patients with CFD for surgeons. METHODS: To address the research purpose, the authors designed and performed a systematic review with meta-analysis. A comprehensive electronic search without date was performed in August 2013. Data extracted from the previously published literature were analyzed with STATA 11.0 software. RESULTS: Relevant data were extracted from 18 studies (487 total participants) and revealed that in CFD patients, the prevalence of the monostotic type was 56% (95% confidence intervals [CI]: 0.42-0.70; P = 0.000) and polyostotic type was 47% (95% CI: 0.31-0.63; P = 0.000); McCune-Albright syndrome was a relatively rare form (7%; 95% CI: 0.02-0.12; P = 0.006). Subgroup analyses indicated that the maxilla was most commonly involved (28%; 95% CI: 0.42-0.70; P = 0.000) in monostotic CFD, followed by the orbital (27%; 95% CI: -0.23-0.76; P = 0.298), mandibular (25%; 95% CI: 0.16-0.35; P = 0.000), frontal (22%; 95% CI: 0.09-0.34; P = 0.001), and temporal bones (12%; 95% CI: 0.03-0.21; P = 0.012). The prevalence of maxilla involvement in polyostotic CFD patients was as high as 30% (95% CI: 0.18-0.42; P = 0.000). CONCLUSION: This meta-analysis found that monostotic and polyostotic forms of CFD shared similar prevalence rates. Furthermore, the maxilla was found to be the most commonly involved bone in both monostotic and polyostotic CFD.

Systematic Analysis of Clinical Outcomes of Bilateral Sagittal Split Ramus Osteotomy With Preoperative Modeling and Postoperative Orthodontic in the Treatment of Mandibular Protrusion.

The purpose of this study was to determine the changes in hard tissues, soft tissues, and teeth after bilateral sagittal split ramus osteotomy and orthodontic treatment for the treatment of mandibular protrusion. Cephalometric analysis was used to evaluate the aesthetic effects and occlusal relationships obtained. The subjects included 11 women and 9 men (aged 18-27 years; average, 20 years) with mandibular protrusion who underwent bilateral sagittal split ramus osteotomy. Based on a preoperative computer-aided manufacturing/design-assisted, model surgical design and an occlusal guide plate, new occlusal relationships were established for the patients. In addition, the preoperative and the end of postoperative orthodontic treatment cephalometric radiographs were systematically analyzed. In all patients, the surgical incisions underwent primary healing, with no infection or osteonecrosis. Significant differences were observed in the preoperative and the end of postoperative orthodontic treatment values of all hard tissue and teeth parameters, except for SNA°, ANB°, GoGn-SN°, SE (mm), NP-FH°, SGn-FH°, OP-FH°, 1-MP°, Li-E (mm). The most obvious significant differences were seen in SNB°, SND°, 1_-NA°, 1_-NA (mm), 1-NB (mm), 1-NB°, Po-NB (mm), NA-PA°, AB-NP°, 1-OP°, Ui-E (mm), and S-N'-B'° (P < 0.001). Postoperative follow-up lasted for 10 to 12 months. All patients eventually achieved normal downjaw relationship, tooth arch forms, and spee curves. There were no evident irregularities of teeth arrangement or abnormal occlusal relationships were observed. All patients were satisfied with their facial appearance and occlusal relationships at the end of postoperative orthodontic treatment. The authors found a precise preoperative model surgical design combined with postoperative orthodontic treatment is a simple and time-saving technique. It can be used to correct mandibular protrusion with satisfactory occlusal relationship, facial appearance, and minimal postoperative complications.

Iatrogenic mandibular fracture associated with third molar removal after mandibular angle osteotectomy.

The extraction of mandibular third molars is a common dental procedure. The complications include hemorrhage, pain, dental fracture, the displacement of teeth or fragments, iatrogenic damage or luxation of the second molar, neurologic injuries, soft tissue damage, subcutaneous emphysema, trismus, swelling, infection, and iatrogenic mandibular fracture. Fracture of the angle of the mandible associated with third molar removal is a rare but severe complication. This article describes a case of mandibular angle fracture associated with third molar extraction after mandibular angle osteotectomy, including a brief review of the literature. The removal of the mandibular angle and the outer cortex of the mandible, especially the external oblique ridge, may contribute to the bone fracture. We conclude that the extraction of the lower third molar must be before the removal of the mandibular angle, and a soft diet for at least 4 weeks postoperatively is essential to prevent late mandible fracture.

Hemimandibular hyperplasia: classification and treatment algorithm revisited.

Hemimandibular hyperplasia (HH) is a developmental asymmetry characterized by three-dimensional enlargement of one half of the mandible. The hyperplastic side usually involves the condyle, condylar neck, ramus, and body, with the anomaly terminating abruptly at the symphysis. The malformation results in the clinical presentation of ipsilateral enlargement of the mandible and tilted occlusal plane, associated with a deviated chin to the contralateral side. Since the first case report of HH in the English literature in 1836, various terminology and classifications were used. In this study, the authors classified the patients into typical and atypical types of HH on the basis of clinical and radiologic observations in an effort to achieve a simplified and efficient surgical management on the basis of the severity of deformity. Accordingly, surgical treatments are designed respectively on the basis of the authors' classification and treatment algorithm. In addition, in view of potential complications arising from condylectomy, none of the patients had undergone condylectomy as part of the surgical treatment. The authors present their experience on the basis of this proposed classification and treatment algorithm with functional and aesthetic outcomes as the end points of this study.

Relations between bone density from computed tomography and bone regeneration after reduction mandibuloplasty.

BACKGROUND: Bone regeneration in the mandibular angle region after reduction mandibuloplasty may compromise the aesthetics of the lower face and thus lead to revision surgery. Bone quality is known to play an important role in osteogenesis. However, no study has evaluated the relationship between mandibular bone quality and bone regeneration volume. METHODS: The bone density of the mandibular angle immediately after surgery (BD) was determined as the grey level in computed tomography (CT) images. Based on the immediate postoperative and long-term follow-up CT images, the volumes of the regenerated angle (VSA) and the regenerated outer cortex (VOC) were measured after model reconstruction, automatic alignment and Boolean operation. Correlation analyses were then performed between VSA and BD, VOC and BD. RESULTS: 23 patients (46 mandibular angles) were included in this study. The average BD was 907.09 ± 111.89 HU. The mean VSA was 201.66 (131.73-357.24) mm3. Spearman correlation analysis revealed a positive correlation between BD and VSA (r = 0.5449, p < 0.0001). The mean VOC was 236.23 ± 151.35 mm3. Pearson correlation analysis found a negative correlation between BD and VOC (r = -0.3501, p = 0.0171). CONCLUSIONS: CT images can provide a quantitative assessment of mandibular bone quality. BD may influence the volumes of bone regeneration in different areas of the mandibular angle portion after reduction mandibuloplasty, in the regenerated angle area positively and in the regenerated outer cortex region negatively. Therefore, slight over-grinding may be a choice to prevent secondary angulation.

Systematic analysis of clinical outcomes of anterior maxillary and mandibular subapical osteotomy with preoperative modeling in the treatment of bimaxillary protrusion.

The purpose of this study was to determine the changes in teeth and hard tissues after preoperative modeling and bimaxillary anterior subapical osteotomy for the treatment of bimaxillary protrusion. Cephalometric analysis was used to evaluate the aesthetic effects and occlusal relationships obtained. The subjects included 19 women and 1 man (aged 19-41 years; average, 29 years) with bimaxillary protrusion who underwent anterior subapical osteotomy of both the maxilla and mandible, with simultaneous genioplasty, if required. Based on a preoperative computer-aided manufacturing/design-assisted and model surgical design and an occlusal guide plate, new occlusal relationships were established for the patients. In addition, the preoperative and postoperative cephalometric radiographs were systematically analyzed. In all patients, the surgical incisions underwent primary healing, with no infection or osteonecrosis. Significant differences were observed in the preoperative and postoperative values of all hard tissue and teeth parameters, except for SGn-FH degrees and Co-MP. The most obvious significant differences were seen in L1-OP°, Id-Pog-Go°, IIA°, U1E-Apog, L1E-Apog, U1E-NA, and L1-NA° (P < 0.001). Postoperative follow-up lasted for 12 to 36 months. All patients eventually achieved normal jaw relationships, tooth arch forms, and Spee curves. No evident irregularities of teeth arrangement or abnormal occlusal relationships were observed. All patients were satisfied with their postoperative facial appearance, except for 1 patient, who underwent repeat surgery because of relapse. With the use of a precise preoperative model surgical design, orthognathic surgery, a simple and time-saving technique, can be used to correct bimaxillary protrusion with satisfactory postoperative occlusal relationship and facial aesthetic appearance and minimal postoperative complications.

Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically?

BACKGROUND: Fibrous dysplasia (FD) is a tumor-like growth that consists of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. The most commonly affected bones are facial bones, causing a number of facial cosmetic and functional problems. METHODS: From December 2008 to July 2012, 10 patients with craniomaxillofacial fibrous dysplasia were treated by conservative resection and local recontouring. The patients were followed up yearly, with an average of 3 years; the longest follow-up period was 5 years. RESULTS: All the 10 patients received appropriate treatment and histopathological examinations were performed to confirm the diagnosis of FD. Four patients with zygoma involved had received partial zygoma osteoectomy and 2 patients received mandibular partial osteoectomy. Average time of follow-up was 3 years, with a range from 1 to 5 years, and all patients obtained satisfactory aesthetic and functional results. CONCLUSION: In most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.

Porous polyethylene implants in orbital blow-out fractures and enophthalmos reconstruction.

OBJECTIVE: To evaluate the efficacy of porous polyethylene sheet implants in reconstruction of orbital blow-out fractures. METHODS: Sixty-eight patients with orbital blow-out fractures were admitted in our center from December 1996 to June 2005. Porous polyethylene sheet implants were used to repair the defects of orbital wall and to correct the enophthalmos. The clinical results of extrinsic eye movement, enophthalmos, hypoglobus (vertical dystopia), visual acuity, and infraorbital nerve anesthesia were analyzed preoperatively and postoperatively. RESULT: Patients stayed in the hospital between 4 and 10 days. The enophthalmos and hypoglobus of all 68 patients was corrected except for one. The patient needs another surgery 6 months after operation to remove a piece of Medpor because the hypoglobus was overcorrected. Diplopia was resolved in 36 of 45 patients postoperatively. Persistent diplopia was found in 9 cases that were complicated orbitozygomaticomaxillary fractures. Visual acuity was improved in 13 of 45 patients, whereas no change was observed in the others. Infraorbital nerve hypoesthesia was resolved in 32 of 43 cases 6 months after operation. Only 1 patient developed postoperative ectropion, for which local suspending was required. No infections and Medpor outcrop were seen after operation. CONCLUSION: Porous polyethylene sheet implant is a very reliable material for reconstruction of the orbital blow-out fractures and restoration of the orbital volume. Overcorrection of 1 to 2 mm is necessary during operation to neutralize the tissue swelling or atrophy.

Application of the 3D digital ostectomy template (DOT) in mandibular angle ostectomy (MAO).

BACKGROUND: Mandibular angle ostectomy (MAO) is a standard approach in reconstruction of facial contour that is commonly used in East Asian patients with prominent mandibular angles (PMA). MAO is commonly performed via an intraoral approach to reduce scar visibility and risk of facial nerve injury. Since this intraoral approach for MAO has limited visual guidance during the procedure, plastic surgeons often perform the operation based on personal clinical experience. Therefore, we designed a 3D digital ostectomy template (DOT) for guidance during surgery to improve the accuracy and safety of MAO. METHODS: 10 female patients (average age 25.3 years) with PMA were enrolled in this study from August 2014 to October 2015. The DOTs were designed and printed preoperatively and utilized in the operation to guide the osteotomy. The excised mandibular angle bone and the DOTs were measured respective to each other. The data were analyzed to verify the feasibility and safety of the DOT. RESULTS: All of the patients were satisfied with the surgical results, and no complications such as fracture, hemorrhage and infection occurred. The distance from gonion (Go) along inferior margin of mandible forward to the distal end of the excised bone is "a". The distance from Go along posterior margin of ramus upward to the distal end of the excised bone is "b". The widest distance from Go to the ostectomy line is denoted by "c". Similarly, the corresponding distance in the DOT is denoted by "a'", "b'", "c'". The statistical results showed that left a vs a', b vs b', c vs c' was 63.27 ± 6.39 mm vs 62.97 ± 6.30 mm (p > 0.05), 23.98 ± 2.25 mm vs 21.83 ± 2.27 mm (p < 0.05), 13.58 ± 2.24 mm vs 13.37 ± 2.14 mm (p > 0.05), respectively. The right a vs a', b vs b', c vs c' was 62.92 ± 5.00 mm vs 62.72 ± 4.99 mm (p > 0.05), 24.03 ± 1.88 mm vs 21.80 ± 1.91 mm (p < 0.05), 13.36 ± 1.70 mm vs 13.22 ± 1.72 mm (p > 0.05), respectively. The results indicate a significant difference between b and b' both on the right and left sides. CONCLUSION: Through the application of DOT in MAO, the accuracy and safety of the operation were improved significantly. Unfortunately, the osteotomy could not be guided well in the posterior rim of the ramus. Further improvements in the surgical template are needed for application in PMA associated with oversized chin deformity or in PMA associated with large mandibular angle and severe involution.

[Application of the digital osteotomy template in the mandibular angle osteotomy ].

Objective: To investigate the application of the digital osteotomy template in the mandibular angle osteotomy,so as to increase the precision and symmetry of the osteotomy. Methods: 8 cases were included in our study (female,average age 25.5).The CT data (DICOM format) were reformatted into 3D images using 3D imaging software (ProPlan).The osteotomy lines were designed on digital 3D theoretical model with ProPlan.Then the statistics of the ostectomy were imported into GeoMagic in the form of STL file to design the 3D osteotomy template.The osteotomy template was fabricated with FDA certificated PLA through RP machine. During operation,the template was inserted into operation area to guide the osteotomy.A line was drawn along the edge of ostectomy plate with a grinding ball and osteotomy was done along the curvilinear line using a goose saw. Results: The removed bone proved to be highly matched with the template.All the post-operative results were satisfactory.There were no complications such as fracture,life-threatening hemorrhage and infection.The post-operative measurement showed good symmetry. Conclusions: With the guidance of osteotomy templates,the surgeon can perform the osteotomy in an accurate way.The precision and symmetry of the osteotomy are greatly improved.

Skeletal stability of bioresorbable fixation in orthognathic surgery: a systemic review.

BACKGROUND: Over the past 20 years, there has been an increase in the use of bioresorbable fixation system in orthognathic surgery, but concerns remain about the stability of fixation. This review is to seek evidence for the effectiveness of bioresorbable fixation systems compared to titanium systems used for orthognathic surgery. METHODS: A systematic review of the scientific literature listed on PubMed, Embase, Cochrane Central Register of Systemic Reviews and Cochrane Central Register of Controlled Trials was performed, up to December 2012. RESULTS: Twenty articles were selected based on inclusion and exclusion criteria: five RCTs and fifteen prospective. We compared these studies, published between 1997 and 2012 and involving 1092 participants examining skeletal stability of bioresorbable fixation in orthognathic surgery. CONCLUSION: This review found that the published data have shown that bioresorbable fixation systems produce reliable skeletal stability.

Single stage surgery for contouring the prominent mandibular angle with a broad chin deformity: en-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG).

BACKGROUND: Various surgical options are reported to address the Asian 'squared face', characterized by a prominent mandibular angle (PMA) associated with an oversized chin deformity; but shortcomings lie in the requirement of multi-stage procedures with the risk of further revision surgery. We have developed a single-stage "Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG)" surgical technique to shorten the period of the surgical treatment and minimize the inherent surgical risks in the multi-staged procedures. METHODS: A retrospective study involving patients (n = 36) presented with prominent mandibular angle and an oversized chin who underwent the operation described from 2010 to 2012 with at least 12 months of follow-up. The surgical and aesthetic outcomes were evaluated through clinical assessment, photography, imaging analysis including preoperative and post-operative patient satisfaction rates. RESULTS: All the patients were satisfied with the improvement in their appearance following surgery; specifically the 'smoothness' of the mandibular inferior border with no 'second mandibular angle'. The width of the mandible was reduced with G-G distance reduced from 119.9 mm ± 3.9-109.7 mm ± 3.5 (p < 0.05). A significant preoperative and post-operative gonial angle (G-A) was found at the left (110.7° ± 9.6 vs 139.9° ± 11.5, p < 0.05) and right side of mandible (111.3° ± 10.7 vs 140.7° ± 11.8, p < 0.05). There was no iatrogenic inferior alveolar nerve or mental nerve injury and a stable aesthetic outcome beyond the first year. CONCLUSION: We demonstrated favourable surgical and aesthetic outcomes with our single-stage en-bloc curved osteotomy surgical technique to reshape the prominent mandibular angle with a broad chin deformity with no increased in surgical risks but a high satisfaction rate and stable outcomes.

Complications of absorbable fixation in maxillofacial surgery: a meta-analysis.

BACKGROUND: The use of titanium during maxillofacial fixation is limited due to its palpability, mutagenic effects and interference with imaging, which lead to the requirement for subsequent removal. The use of a biologically absorbable fixation material will potentially eliminate these limitations. In this meta-analysis, we analyzed the complications of absorbable fixation in maxillofacial surgery. METHODS: We performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews and Cochrane Central Register of Controlled Trials for trials published through December 2012. Data extracted from literature were analyzed with Review manager 5.0.24. RESULTS: Relevant data was extracted from 20 studies (1673 participants) and revealed that patients in the absorbable group had significantly more complications than those in the titanium group (RR = 1.20; 95% CI: 1.02-1.42; P = 0.03) in all enrolled maxillofacial surgeries. For bimaxillary operation subgroup, the absorbable fixation group did not have a significant increase in complications when compared with the titanium group (RR = 1.89; 95% CI: 0.85-4.22; P = 0.12). There was no significant difference observed between the absorbable and titanium groups receiving a bilateral sagittal split ramus osteotomy (BSSRO) (RR = 1.45; 95% CI: 0.84-2.48; P = 0.18) and Le Fort I osteotomy (RR = 0.65; 95% CI: 0.34-1.23; P = 0.18). The combined results of the five trials revealed that the absorbable group had a significantly lower rate of complications compared to the titanium group (RR = 0.71; 95% CI: 0.52-0.97; P = 0.03) in fracture fixation. CONCLUSION: This meta-analysis shows that absorbable fixation systems used for fixation in maxillofacial surgery do not have adequate safety profiles. Subgroup indicated the safety of absorbable fixation systems was superior during fracture fixation. The absorbable fixation systems tend to have a similar favorable safety profile as titanium fixation during Le Fort I, bimaxillary operation and BSSRO.

Correction of hemifacial atrophy using free anterolateral thigh adipofascial flap.

Treatment of hemifacial atrophy presents a challenge for reconstructive surgeons. Previous studies have described numerous methods for the correction of facial asymmetry. We present our experience with treatment of hemifacial atrophy using a microsurgical anterolateral thigh adipofascial flap procedure and other adjunctive measures. This method is similar to that used for the free anterolateral thigh flap, but only the deep fascia of the anterolateral thigh and subcutaneous fatty tissue above the fascia were harvested. This flap procedure was used in 32 patients with moderate or severe hemifacial atrophy. In the first stage, the anterolateral thigh adipofascial flap procedure was used in all the patients, of whom eight accepted a porous polyethylene implant along with the anterolateral thigh adipofascial flap to reconstruct the skeleton. In the second stage, ancillary procedures including porous polyethylene implantation, liposuction debulking, fat injection and flap re-suspension were performed to refine the outcome in 28 patients. The anterolateral thigh adipofascial flap is advantageous in that it can provide a reliable vascular pedicle with relatively thin, pliable soft tissue and direct primary closure of the donor site.