Efficacy and Cost of Maxillary Patient-Specific Implants in Orthognathic Surgery: A Review of Three Patient Cases.

INTRODUCTION: Patient-specific implants (PSIs) are accurate, efficient alternatives to traditional plate fixation. They are well-suited for use in procedures that require the utmost accuracy, stability, and efficiency. Although PSIs have demonstrated such qualities in craniomaxillofacial reconstruction, they have so far found limited utilization elsewhere. CASE PRESENTATION: We explored the departmental protocol for Lefort 1 PSI orthognathic surgery at a high-volume, tertiary referral center. Three cases were selected that matched predetermined criteria, which included treatment by the same surgical team, concurrent Lefort 1 osteotomy and bilateral sagittal split osteotomy, Angle's type 3 malocclusion, lack of interdental osteotomies, and American Society of Anesthesiologists classification 2 or less without metabolic or osseous diseases. The operative outcomes from these patients were then compared to similar cases also meeting the same criteria and conducted within the same time period. CONCLUSION: The use of PSI in Lefort 1 osteotomy is associated with anatomically sound designs that could contribute to postoperative stability of the jaws. They also have not shown increased rates of complications such as infection, dehiscence, or relapse at 6 weeks postoperatively but may in fact decrease the operative duration. These findings are consistent with the results gleaned from literature on the use of PSI in craniomaxillofacial reconstruction.

The anatomic structure of the inferior alveolar neurovascular bundle in the third molar region.

PURPOSE: The arrangement of the structures within the inferior alveolar neurovascular bundle has not been clearly defined. Because this could be of importance in surgery involving the inferior alveolar canal, a study was undertaken. MATERIALS AND METHODS: The inferior alveolar neurovascular bundle was dissected from 8 cadaveric mandibles and examined for the arrangement of the inferior alveolar artery, vein, and nerve. Histologic sections were taken for examination, and simultaneously, the bundle was exposed as part of a clinical surgical procedure for a marginal resection of the mandible. RESULTS: All 3 studies confirm that the inferior alveolar vein lies superior to the nerve and that there are often multiple veins. The artery appears to be solitary and lies on the lingual side of the nerve, slightly above the horizontal position. This position appeared to be consistent in all cases. CONCLUSIONS: Knowledge of the arrangement of the inferior alveolar artery vein and nerve within the inferior alveolar canal can be of importance in surgical procedures that may involve these structures. Dentoalveolar surgery, implant-related surgery, and surgery for trauma or pathology could involve these structures.