The effect of combined surgery and physiotherapy on the facial asymmetry in patients with congenital muscular torticollis: a retrospective cohort study.

The aim of this study was to assess the influence of surgical therapy, intraoperative evaluation, and immediate physiotherapy on the facial asymmetry of patients with congenital muscular torticollis (CMT). Patients who underwent a combination of unipolar sternocleidomastoid muscle release with perioperative physiotherapy between 2014 and 2020 in the Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen were enrolled. Three-dimensional photographs of the face acquired 2 months preoperatively and 1.5-2 years postoperatively were assessed. Based on 43 patients, there was a significant improvement in the asymmetry indices (angles between bilateral exocanthion, bilateral cheilion, and nasion-gnathion lines): mean ± standard deviation reductions in indices (Ex-Ex)-(Ch-Ch), (Ex-Ex)-(Na-Gn), and (Ch-Ch)-(Na-Gn) of 0.88 ± 1.08° (P < 0.001), 1.04 ± 1.26° (P < 0.001), and 0.21 ± 1.06° (P = 0.024), respectively. Analysis of covariance (ANCOVA) showed that intervention at an early age (P = 0.017) and left-sided torticollis (P = 0.030) were associated with a significantly greater improvement in the facial asymmetry. This study found that the use of combined surgery and physiotherapy reduced the facial asymmetry of patients with CMT at 2 years postoperatively. Early intervention and left-sided torticollis were associated with a greater improvement in the facial asymmetry. This indicates that attention should be given to early intervention and right-sided CMT cases postoperatively.

Surgical accuracy in 3D planned bimaxillary osteotomies: intraoral scans and plaster casts as digital dentition models.

The aim of this study was to assess whether the use of intraoral scans (IOS) is an eligible alternative to conventional plaster casts in terms of surgical accuracy of three-dimensionally planned bimaxillary osteotomies. This retrospective cohort study included patients who underwent bimaxillary surgery between 2016 and 2020 in the Department of Oral and Maxillofacial Surgery at Radboud University Medical Center, Nijmegen. Three-dimensional virtual planning was performed with the use of plaster casts in one group and IOS in the other group. Cone beam computed tomography scans were acquired preoperatively and at 1 week following surgery. By using voxel-based matching, the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned maxillary movements and those achieved. Of 152 patients, 113 were documented with plaster casts and 39 with IOS. The surgical accuracy was comparable in terms of maxillary vertical, sagittal, and transverse translations, as well as roll and yaw. Maxillary pitch (difference 0.55 ± 0.26°; P = 0.001) was in favour of the IOS group. This study demonstrated that IOS can be used as an alternative to conventional plaster casts in the three-dimensional planning of bimaxillary osteotomies.