Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience.

The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes. A total of 148 SF procedures were performed during this period, which corresponded to only 9.2% of the total orthognathic surgeries performed, which means that we have broadened the exclusion criteria instead of reducing them. Surgical tips include interdental corticotomies solely in cases of anterior crowding and leaving the intermaxillary fixation miniscrews in place postoperatively for orthodontic skeletal anchorage. The mean duration of postoperative orthodontic treatment was reduced in comparison to conventional surgery (36.8 vs 87.5 weeks). The overall degree of satisfaction was high not only for the patients, but also for the orthodontists and surgeon. SF is especially indicated for patients who desire an immediate aesthetic result, with short-term orthodontics, or for treatment of sleep-related breathing disorders, if they meet the established criteria.

Temporomandibular joint arthrocentesis guided by ultrasonography: An anatomical study.

The temporomandibular joint (TMJ) arthrocentesis is a common procedure in maxillofacial surgery departments for the treatment of TMJ dysfunction. The use of ultrasonography in this area is rare, and in the vast majority of cases only as a diagnostic, and non-therapeutic use. Through this study we propose the equipment and ultrasound parameters necessary to obtain detailed and practical images when using ultrasonography as a therapeutic guide in arthrocentesis of TMJ. In addition, we provide data regarding the placement and working angulations of both the ultrasound probe and the needle that are ideal for facilitating image-guided puncture. It is a simple technique, with a relatively short learning curve, and that can provide considerable intraoperative help to the surgeon.