Photography in orthognathic surgery: A standardized protocol and storage legal implications.

Medical photography is an essential tool in orthognathic surgery to facilitate diagnosis, preoperative planning, and follow-up. Photographic documentation has clinical, research, teaching and legal applications. An accurate diagnostic approach and surgical planning of dentofacial deformity requires the ability to work with reproducible and measurable photographic images. It must also respect certain legislative rules for its use within a health institution and the dissemination of images in the educational and scientific framework. We propose through this narrative review a standardized protocol to obtain reproducible images in the different planes of space. We also review and discuss fundamental points for setting up a photographic room dedicated to photography in orthognathic surgery.

Impaired tongue motor control after temporomandibular disorder: A proof-of-concept case-control study of tongue print.

BACKGROUND: Temporomandibular disorder (TMD) perturbs the tongue motor control and consequently impairs oral function, but strength training reduces this impairment. However, tongue motor control is widely reduced to a matter of strength. OBJECTIVES: To investigate the accuracy of the tongue placement as a measure of tongue motor control in patients with TMD compared with age- and sex-matched healthy participants. MATERIAL AND METHODS: This proof-of-concept case-control study was prospective, observational, and part of the TMIQ study (NCT04102306). After pointing against a wood stick while maintaining the tongue as sharp as possible, the examinator drew the contour of the tongue print on the wood stick, which was then scanned for image analyses to compute the area for each participant using ImageJ. RESULTS: A total of 94 participants were included, all patients with TMD (n = 47) diagnosed with myalgia, 61% with intra-articular joint disorder accordingly to the DC/TMD. The median (IQR) tongue print area was 117 (111) mm2 for the TMD group and 93.5 (76.2) mm2 for the control group (V = 352, p = .04) and the median [95% confidence interval] difference was 25.4 [1.3; 51.0] mm². Overlapping of the 95% confidence intervals of the area evidenced no significant difference between the categories of the DC/TMD. The corrected each area-total correlation (r = .24) suggests a reasonably homogenous thus valid measure. CONCLUSION: The results suggest that TMD impairs the motor control of the tongue. Therefore, the sharpest tongue pointing test may constitute a simple and accessible clinical tool to assess the accuracy of tongue placement in TMD patients. The study was registered on ClinicalTrial.gov with identification number NCT04102306.

Artificial intelligence for oral and maxillo-facial surgery: A narrative review.

Artificial Intelligence (AI) is a set of technologies that simulate human cognition in order to address a specific problem. The improvement in computing speed, the exponential production and the routine collection of data have led to the rapid development of AI in the health sector. In this review, we propose to provide surgeons with the essential technical elements to help them understand the possibilities offered by AI and to review the current applications of AI for oral and maxillofacial surgery (OMFS). The review of the literature reveals a real research boom of AI in all fields in OMFS. The algorithms used are related to machine learning, with a strong representation of the convolutional neural networks specific to deep learning. The complex architecture of these networks gives them the capacity to extract and process the elementary characteristics of an image, and they are therefore particularly used for diagnostic purposes on medical imagery or facial photography. We identified representative articles dealing with AI algorithms providing assistance in diagnosis, therapeutic decision, preoperative planning, or prediction and evaluation of the outcomes. Thanks to their learning, classification, prediction and detection capabilities, AI algorithms complement human skills while limiting their imperfections. However, these algorithms should be subject to rigorous clinical evaluation, and ethical reflection on data protection should be systematically conducted.

[Orthodontic-surgical protocols: special cases requiring close collaboration between the surgeon and the orthodontist from the beginning of the treatment]. / Protocoles orthodontico-chirurgicaux : les cas particuliers nécessitant une collaboration étroite entre le chirurgien et l'orthodontiste dès le début du traitement.

In order to guarantee optimal care for our patients during orthodontic-surgical protocols and given the large number of interveners, some special cases request an even closer collaboration between practitioners. This article presents the very specific cases requiring even closer collaboration and specific care in order to optimize appointments. The collaboration between the surgeon and the orthodontist is particularly essential and will guarantee the excellence and the precision of the final result.

In-house 3D printing: Why, when, and how? Overview of the national French good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery.

3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Société Française de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.

Severity and long-term complications of surgical site infections after orthognathic surgery: a retrospective study.

Surgical site infections (SSI) occur in 1.4% to 33.4% of cases after orthognathic surgery. This type of complication is a major concern to surgical teams, but there is no consensus for the prevention and treatment of SSI in orthognathic surgery. The purpose of this descriptive study was to evaluate the severity and the consequences of postoperative infections. The charts of all the patients operated on by the orthognathic surgery team between January 2015 and July 2017 were collected. All types of orthognathic procedures (Le Fort I maxillary osteotomy, bilateral sagittal split mandibular osteotomy, and genioplasty) were screened, and patients diagnosed with SSI were included. Demographic data, timing and severity of the infection, as well as long-term complications were recorded. Five hundred and twelve patients were screened. Forty-one patients (8%) presenting with SSI were included. There were 18 men and 23 women. The site of the infection was mandibular for 38 patients (92.7%) and maxillary for 3 patients (7.3%). The average time between surgery and infection was 31.5 days. Twenty-four patients received isolated oral antibiotics for inflammatory cellulitic reaction (58.8%), 15 patients had a localized collection treated by incision and drainage under local anesthesia (36.6%), and 2 patients had an extensive collection requiring surgical drainage under general anesthesia (4.9%). Five patients (12.2%) needed hardware removal for plate loosening, and 2 patients (4.9%) developed chronic osteomyelitis. Infection following orthognathic surgery is easily treated most of the time with no long-term complications. In cases of patients with potential risk factors for severe infection, antibiotics may be given with curative intents.

[Orthognathic surgery of mandibular asymmetry: which results can we expect with and without chin wing? A cohort out of 51 cases]. / Traitement ortho-chirurgical de la latéromandibulie : quels résultats escompter avec et sans chirurgie du contour mandibulaire ? Une étude de cohorte sur 51 cas.

INTRODUCTION: The aim of this retrospective cohort is to evaluate the amount of postsurgical correction of soft and hard tissues in patients with mandibular asymmetries and to compare the results with and without surgery of the lower mandibular contour (chin wing…). MATERIAL AND METHOD: Mandibular asymmetries cases of three surgeons were systematically included. The angles of deviation of the chin, bi-commissural, bi-gonic and occlusal were measured on face photography and radiography. A pre and post-surgical comparison was performed and the amount of correction was analyzed via the Wilcoxon statistical test. RESULTS: 51 patients (44 women and 7 men) were included. After surgery, the correction is significant for all measurements with an improvement of 44 to 60% depending on the measured angles. No patient is normalized but the small initial mandibular asymmetries are the closest to normal after surgery. The correction of the bi-commissural angle is controlled without being optimal (60% correction). The difficulty remains the horizontalization of the bi-gonial plan which is only corrected at 45%. Patients with mandibular margin surgery (chin wing…) showed the greatest improvement in bi-gonial (p = 0.0142) and occlusal (p = 0.0154) angles. CONCLUSION: If surgery allows a significant correction of facial dissymmetry, this is not complete. Surgical procedures on the lower edge of the mandible such as the chin wing could provide a better correction especially for bi-gonial and occlusal angles.

Mandibular Advancement Means Lower Facial Enlargement: A 2-Dimensional and 3-Dimensional Analysis.

PURPOSE: Bilateral sagittal split osteotomy (BSSO) is frequently used to treat Class II malocclusion for functional and esthetic purposes, with expected changes in the profile. The goal of this study was to assess transversal changes in mandibular advancement by comparing 3-dimensional (3D) photogrammetric modifications and 2-dimensional (2D) radiographic enlargement. MATERIALS AND METHODS: A cohort study was conducted of patients who underwent an isolated advancement BSSO (Obwegeser-Dal Pont II type) for a Class II malocclusion. All patients had 3D photogrammetric and 2D radiographic evaluations before and after surgery. Frontal cephalograms were used to measure the evolution of bigonial distance (BGD) and 3D photographs were used to measure the evolution of cutaneous BGD (CBGD). RESULTS: Fourteen patients were included. Mean mandibular advancement was 6 mm. BGD (+6.1 mm; P < 10-3) and CBGD (+4.2 mm; P = .0017) were significantly increased. The mean ratio of soft tissue response to transversal skeletal changes was 0.81. CONCLUSION: This 2D and 3D analysis of transversal modifications shows that advancement with the BSSO is responsible for marked lower third facial enlargement. This parameter must be taken into account during the preoperative esthetic assessment to ensure the provision of pertinent information to the patient and the consideration of complementary surgical correction.

[Dental complications during orthodontic preparation and orthognathic surgery]. / Complications dentaires de la préparation orthodontique et de la chirurgie orthognathique.

INTRODUCTION: Orthodontic-surgical treatment can present risks to the dental organ and the periodontium. Despite the low incidence of such cases, these complications can compromise a treatment plan. Practitioners should be aware of these potential complications, take them into account during treatment in order to reduce their negative impact and, if necessary, manage them by orthodontic-surgical collaboration. MATERIALS AND METHODS: In this article, the authors present several potential complications that can occur during treatment. CONCLUSION: The information given to the patient about the risks inherent in the implementation of an orthodontic-surgical protocol must necessarily include the risks of lesion to the dental organ and the periodontium.

[Mandibular asymmetry: determination of a reliable skin measurement technique]. / Latéromandibulie : détermination d'une mesure cutanée fiable.

INTRODUCTION: Clinical measurements in the frontal view underevaluate chin deviation in mandibular asymmetry. The aim of this descriptive study is to search for a reliable method of measuring deviant chins using a facial X-ray as reference. MATERIAL AND METHOD: Seventy patients with mandibular asymmetry who had consulted a maxillofacial surgeon were systematically included. Age, sex, cephalometric characteristics, reasons for patient consultation and type of surgery were collected. Two cephalometric methods were tested with respect to the medial sagittal plane (PSM) to compare the assessment of mandibular asymmetry on soft tissue and by cephalometry. RESULTS: On average, the patients selected were young (26 years +/- 9), women (75% of cases), presented open bite (average FMA: 28° +/- 8°), a skeletal class III tendency, a left-side shift of the chin (63% of cases). They consulted for both aesthetic and functional reasons (51% of cases) and required bimaxillary surgery (66% of cases). Comparison between the photographic angle (formed by the PSM and the line passing through the nasion and reaching the chin point) and the radiographic angle (formed by the PSM and the line passing through the Crista Galli process and the bony chin point angle) showed no significant difference (p = 0.937) and is thus reliable.

Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips.

Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

[Unfavorable outcomes in orthognathic surgery]. / Chirurgie orthognathique : les cas défavorables∗.

Successful completion of an orthodontic-surgical protocol requires faultless involvement of all the parties concerned, both the practitioners and the patient. When the result achieved does not match esthetic and/or functional expectations, the outcome may be seen as a failure by the patient, the practitioners or even both. Two situations comprising a potential for failure will be analyzed here: unfavorable outcomes and the psychological difficulties involved in accepting a new face.

Management of dentoskeletal deformity due to condylar resorption: literature review.

OBJECTIVES: The aim of this review was to examine all publicly available literature on the current treatments of the dentoskeletal deformity due to condylar resorption and their outcomes and to suggest management guidelines. STUDY DESIGN: A systematic review was performed of all literature located on the electronic PubMed database from 1970 to 2012. RESULTS: The search resulted in 21 papers and 210 cases treated from 1991 to 2012. Orthognathic surgery was the most commonly used option (42%) and was sometimes combined with open joint surgery (19%). Stability was observed, respectively, in 57% and 100% of the orthognathic surgery and open joint surgery cases. Condylectomy and reconstruction with chondrocostal graft or temporomandibular joint total joint prosthesis were used in 19% and 10% of all cases of orthognathic surgery and open joint surgery with good results (95% and 100%, respectively). Osteogenic distraction was anecdotic (1%). Nine percent of all cases received conservative treatment. CONCLUSIONS: Larger comparative studies are necessary to obtain evidence-based recommendations.

[Skeletal discrepancies: could we avoid surgical procedures?]. / Dysmorphoses dento-squelettiques : peut-on éviter à tout prix la chirurgie ?

Orthodontic-surgical protocols are nowadays considered as the state-of-the-art in cases of skeletal dentomaxillary dysmorphosis. However, for some reasons, it may happen that unquestionable indications for orthodontic-surgical procedures are not respected, patients being treated by orthodontics alone. This kind of mistake in the treatment planning lay the patient open to various potential complications such as: abnormal duration of the orthodontic treatment, dental root resorptions, questionable tooth extraction, unfavorable facial aesthetics, treatment instability... The authors discuss these points illustrated by clinical cases. Although orthognathic surgery protocols became considerably simplified these last two decades, orthodontic-surgical protocols are still relevantly considered as heavy both by patients and practitioners. As a consequence, their indication must be carefully weighed by a multidisciplinary team, keeping in mind that these protocols represent the ultimate functional and aesthetic treatment for dento-skeletal dysmorphoses.

Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures.

In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the effectiveness and complications of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses some of its other benefits and disadvantages. Notes of 227 patients with facial fractures treated by wire internal fixation at department of stomatology and maxillofacial surgery of CHU Souro Sanou, Burkina Faso between 2006 and 2010 are reviewed retrospectively. A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site. Wire internal fixation may be a reasonable alternative for the surgical treatment of non-comminuted facial fractures and those without bone substance loss, in the setting of limited resources.

Maxillary melanotic neuroectodermal tumor of infancy management: is conservative surgery the best approach?

Melanotic neuroectodermal tumor of infancy (MNTI), an uncommon neoplasm that involves predominantly the maxilla, is classically benign but clinically aggressive. Surgery is the mainstay of the treatment with a proven efficacy, but its optimal method is not entirely clear. A case of maxillary MNTI in a 4-month-old male infant treated by radical surgery without recurrence after more than 3 years of follow-up is presented. On the basis of this experience and a review of the literature, the optimal method of MNTI surgery is discussed. To improve the prognostic of this neoplasm, the role of conservative surgery should be limited to the treatment of tumors where clear surgical margins excision should require sacrifice of functional or vital structures.

Surgical correction of transverse skeletal abnormalities in the maxilla and mandible.

The correction of transverse skeletal abnormalities occupies a special place in orthognathic surgery. Maxillofacial surgeons employ a variety of techniques, but treatment stability remains a common problem. This paper presents a range of therapeutic options with special emphasis on two little-known techniques for correcting transverse skeletal abnormalities: symphyseal distraction and mandibular constriction. These techniques are described and their indications discussed.

[Orthognathic surgery is a team work!]. / La chirurgie orthognathique est un travail d'équipe !

Orthodontic-surgical treatment of dentofacial anomalies involves a multidisciplinary approach that demands to be finely coordinated in order to get a good result. Historically, orthognathic surgery stemmed from the close collaboration between the orthodontist and the maxillo-facial surgeon; however thanks to the collaboration of many other specialists along the diagnostic and therapeutic process, orthognathic surgery nowadays reached an unprecedented level of quality, reliability, and safety. We discuss herein the role of the various specialists that may be involved in the treatment of a patient requiring an orthodontic-surgical coordinated approach, as we see it in the Department of MaxilloFacial Surgery of Centre Hospitalier Lyon-Sud.