Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial.

OBJECTIVES: The aim of the present study was to compare conventional (CSP) versus customized virtual surgical planning (VSP) in bimaxillary orthognathic surgery. The primary goal was to compare the accuracy of defined angles. The secondary purpose was to analyze the accuracy of the splints, the time required for surgery, and the costs of both methods. MATERIALS AND METHODS: A total of 21 patients (nCSP = 12; nVSP = 9) treated by two-jaw orthognathic surgery were analyzed prospectively between the years 2014 and 2016. Customized VSP consisted of virtual planning as well as CAD/CAM printing of splints and pre-bent osteosynthesis plates. The evaluated parameters were the difference between planned and postoperative situation (SNA/SNB/ANB), accuracy of splints, time required for surgery (min), and total costs of planning (€). RESULTS: When compared to CSP, VSP appears to be a more accurate method for orthognathic treatment planning with significant differences in the angle outcome (SNA p < 0.001; SNB p = 0.002; ANB p < 0.001). There were significant differences in splint accuracy in favor of CAD/CAM splints (p = 0.007). VSP significantly reduced the duration of operation (p = 0.041). Nevertheless, VSP increased the total costs (481.80 € vs. 884.00 €). CONCLUSIONS: When using virtual 3D technology in combination with printed acrylic splints, 3D models of the jaws and pre-bent osteosynthesis, there is a noticeable reduction in the duration of the operation in conjunction with an improvement in accuracy. CLINICAL RELEVANCE: Virtual model surgery and the prefabrication of splints and plates may replace traditional orthognathic surgery as it becomes cost-effective.

The Microsurgical Approach in Primary Cleft Rhinoplasty-An Anthropometric Analysis.

PURPOSE: Oral and maxillofacial surgeons use different approaches to repair the nasal deformity of patients with a cleft lip deformity, differing in technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the cleft nasal deformity at 4 to 6 weeks of life using a microscope. MATERIALS AND METHODS: Twenty-seven newborn patients with a cleft lip deformity were treated by primary repair of the nasal deformity using a microscope at 4 to 6 weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel (Plast Reconstr Surg 103:1491, 1999), and trans-columellar sutures. All patients were photographed at specific time points up to 1 year after surgery. Established angles and distances were analyzed and compared with normal values of age-matched children by Farkas (Anthropometry of the Head and Face [ed 2]. New York: Lippincott Williams and Wilkins, 1994). RESULTS: All parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values. CONCLUSION: The authors recommend the early treatment of cleft nasal deformity using microscopic surgery because it shows stable and symmetrical results at least up to 1 year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.

Pathophysiology of the Eustachian tube--relevant new aspects for the head and neck surgeon.

OBJECTIVES: The impact of cranio-maxillofacial procedures upon Eustachian tube function is still largely unknown. The aim of this presentation is to depict new aspects of Eustachian tube function and to demonstrate its importance to cranio-maxillofacial surgery. METHODS: Two different groups of patients were examined both clinically and by MRI of the Eustachian tube region. One of these groups comprised 15 adult patients with a history of cleft palate; another consisted of 32 patients with a history of a so-called patulous Eustachian tube. RESULTS: Clinical and MRI-findings revealed that the problem of persistent chronic middle ear disease with cleft palate patients depends crucially on the integrity of the pterygoid hamulus and of the tensor veli palatini muscle after cleft palate repair. The masticatory muscles on the other hand also play an important role in Eustachian tube function in non-cleft patients. CONCLUSION: The maxillofacial surgeon should be aware that he holds a key position for preventing as well as treating Eustachian tube pathophysiology.

A three-dimensional comparison of the pharyngeal airway after mandibular distraction osteogenesis and bilateral sagittal split osteotomy.

PURPOSE: The goal of this retrospective study was to examine the radiological changes in the pharyngeal airway following mandibular distraction osteogenesis (DO) and bilateral sagittal split osteotomy (BSSO). MATERIAL AND METHODS: Between 2005 and 2009, a total of 41 nonsyndromic patients underwent a mandibular osteotomy (nDO = 23; nBSSO = 18). Digital volume tomography images were created for preoperative and postoperative evaluations of both groups. The Dolphin 3D program was used for comparative analysis of the pharyngeal airways. RESULTS: After DO, the airway volumes (VOL) improved by 6.8 mL. In comparison, an improvement of 5.9 mL was observed as result of BSSO. The minimum axial areas (AREA) of the enlargements increased by 109.1 mm(2) with DO and 103.1 mm(2) with BSSO. The airway areas (SA) increased by 193.8 mm(2) with DO and 185.2 mm(2) with BSSO. There were no significant differences between two surgical procedures in terms of the parameters describe above (pVOL = 0.358; pAREA = 0.752; pSA = 0.777). However, the initial preoperative values (pVOL = 0.020; pAREA = 0.005) and the patients' ages (pAREA = 0.042; pSA = 0.007) did have significant effects on the postoperative values. CONCLUSION: Both DO and BSSO expanded the pharyngeal airways of all nonsyndromic patients.