Comprehensive analysis of lateral nasal wall anatomy to optimize the osteotomy in different skeletal patterns.

PURPOSE: Variations in nasal wall anatomy are crucial in patients with dentofacial deformities undergoing Le Fort I osteotomy. These structural variations heighten the potential for complications during surgical procedures. Hence, the study focused on evaluating the differences in the lateral nasal wall anatomy across different skeletal Classes. METHODS: This study evaluated 86 patients aged 18-43 years with different skeletal Classes. In the axial images acquired from coronal sections, two angulations and the linear distances of the lateral nasal wall were measured in Class I, II, and III patients. The measurement between the piriform opening and the most anterior point of the greater palatine foramen was evaluated in three parts regarding the osteotomy line. Differences between the skeletal patterns were analyzed using an independent sample t-test and Mann-Whitney U test with a significance level of 0.05. The intra-class correlation coefficient was calculated for inter-observer and intra-observer agreement. RESULTS: There was a statistically significant difference between Class I and Class II subjects regarding the anterior lateral nasal wall (p = 0.011) and anterior nasal thickness (a) (0.004). There was a significant difference between Class I and Class III patients regarding anterior nasal thickness (a) (p < 0.001) and total lateral nasal wall length (p < 0.001). CONCLUSION: For instance, the measurements of Class III and Class II patients were relatively different from those of the Class I patients. Therefore, preoperative Cone-Beam Computed Tomographic analysis should be performed for each patient prior to Le Fort I osteotomy to ensure that the procedure is performed safely.

Validation of a fully automatic three-dimensional assessment of orthognathic surgery.

The aim of the present study was to propose and validate FAST3D: a fully automatic three-dimensional (3D) assessment of the surgical accuracy and the long-term skeletal stability of orthognathic surgery. To validate FAST3D, the agreement between FAST3D and a validated state-of-the-art semi-automatic method was calculated by intra-class correlation coefficients (ICC) at a 95 % confidence interval. A one-sided hypothesis test was performed to evaluate whether the absolute discrepancy between the measurements produced by the two methods was statistically significantly below a clinically relevant error margin of 0.5 mm. Ten subjects (six male, four female; mean age 24.4 years), class II and III, who underwent a combined three-piece Le Fort I osteotomy, bilateral sagittal split osteotomy and genioplasty, were included in the validation study. The agreement between the two methods was excellent for all measurements, ICC range (0.85-1.00), and fair for the rotational stability of the chin, ICC = 0.54. The absolute discrepancy for all measurements was statistically significantly lower than the clinical relevant error margin (p < 0.008). Within the limitations of the present validation study, FAST3D demonstrated to be reliable and may be adopted whenever appropriate in order to reduce the work load of the medical staff.

Comparative Analysis of Temperature-Responsive Hydrogel (PF 72) for Postoperative Pain After Bimaxillary Surgery: A Retro-spective Study.

Bimaxillary surgery is a painful invasive procedure in plastic surgery. Pain control is typically achieved using intravenous analgesics. We aimed to investigate the efficacy of a novel temperature-responsive hydrogel, PF72, mixed with ropivacaine, as a local pain management solution when applied directly to the surgical site following orthognathic surgery. The study was conducted from October 2022 to July 2023 and included a cohort of 40 candidates for orthognathic surgery, encompassing LeFort I maxillary ostectomy and sagittal split ramus osteotomy. The participants were divided into an Injection group (n = 20), where PF72 was administered at the surgical site before the orthognathic surgery, and a Control group (n = 20), which relied solely on intravenous analgesics. Pain was evaluated at 3, 6, 24, 48, and 72 h after surgery using a numerical rating scale (NRS). The mean NRS scores at 24 h were 6.35 and 4 for the Control and Injection groups, respectively. The mean NRS scores at 72 h were 3.4 and 2.55 for the Control and Injection groups, respectively. Patients who received PF72 experienced less pain than those who received intravenous analgesics. These findings underscore the potential of PF72 as an effective alternative for enhancing pain management in patients undergoing orthognathic surgery.Level of Evidence III Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study.

OBJECTIVE: Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. METHODS: Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. RESULTS: Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. CONCLUSION: Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.

[Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion].

OBJECTIVE: To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery. METHODS: In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T0) and 1-week postoperative CT (T1) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP. RESULTS: The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP. CONCLUSION: VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.

Three-dimensional positioning of the maxilla using novel intermediate splints in maxilla-first orthognathic surgery for correction of skeletal class III deformity.

OBJECTIVES: Successful orthognathic surgery requires accurate transfer of the intraoperative surgical plan. This study aimed to (1) evaluate the surgical error of a novel intermediate splint in positioning the maxilla during maxilla-first orthognathic surgery and (2) determine factors influencing surgical error. MATERIALS AND METHODS: This prospective study examined 83 patients who consecutively underwent Le Fort I osteotomy for correction of skeletal class III deformity using a novel intermediate splint and a bilateral sagittal split osteotomy. Surgical error was the outcome variable, measured as the difference in postoperative translational and rotational maxillary position from the virtual plan. Measures included asymmetry, need and amount for mandibular opening during fabrication of intermediate splints, and planned and achieved skeletal movement. RESULTS: Mean errors in translation for vertical, sagittal, and transversal dimensions were 1.0 ± 0.7 mm, 1.0 ± 0.6 mm, and 0.7 ± 0.6 mm, respectively; degrees in rotation for yaw, roll, and pitch were 0.8 ± 0.6, 0.6 ± 0.4, and 1.6 ± 1.1, respectively. The transverse error was smaller than sagittal and vertical errors; error for pitch was larger than roll and yaw (both p < 0.001). Error for sagittal, transverse, and roll positioning was affected by the achieved skeletal movement (roll, p < 0.05; pitch and yaw, p < 0.001). Surgical error of pitch positioning was affected by planned and achieved skeletal movement (both p < 0.001). CONCLUSIONS: Using the novel intermediate splint when performing Le Fort I osteotomy allowed for accurate positioning of the maxilla. CLINICAL RELEVANCE: The novel intermediate splint for maxillary positioning can be reliably used in clinical routines.

Le fort I osteotomy with or without concomitant removal of upper third molars: A prospective cohort study of intraoperative findings, related complications, and level of pterygomaxillary separation after down-fracture.

The main objective of our study was to assess the clinical implications of concomitant intraoperative removal of maxillary third molars (M3M) with the Le Fort I osteotomy 'twist' technique (LF1twist). A prospective comparative study was carried out regarding the necessity of bone trimming around the pedicle, intra- and postoperative complications, surgery time, and the level of pterygomaxillary junction (PMJ) separation following LF1twist with concomitant intraoperative removal of M3M (test group) versus LF1twist alone (control group). Outcome parameters were assessed from clinical and radiographic measurements. In total, 100 surgery sites were included (50 in each group). The mean surgery time was 53.4 ± 7.8 min, with nonsignificant differences between groups. The frequency of intraoperative complications was negligible, with no significant differences between groups - though all bleeding events (n = 4) occurred when M3M was not removed concomitantly. No postoperative complications were recorded. Percentages of disarticulations occurring at the PMJ were similar in both groups. In conclusion, the results demonstrate that removal of M3M in conjunction with LF1twist does not imply additional surgery time, or differences regarding the level of PMJ separation or perioperative complications. Furthermore, the concomitant procedure reduces the amount of maxillary and palatal bone in the disjunction area, which facilitates down-fracture and field clearing for maxillary repositioning.

Surgery-First Orthognathic Approach for Correction of Dentofacial Deformity in Unilateral Cleft Lip and Palate.

BACKGROUND: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. METHODS: Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. RESULTS: A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. CONCLUSION: These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Objective assessment of visual attention in orthognathic surgery training based on eye tracking.

The aim of this study was to investigate the differences in visual attention between novices and orthognathic experts, as well as to provide evidence for use in developing and optimizing training strategies for orthognathic surgery. Novice and orthognathic experts were recruited, and their distributions of visual attention were monitored via an eye-tracking device while they watched orthognathic surgery videos. The percentages of visual fixation duration devoted to the areas of interest - surgical objects, instruments controlled by the main surgeon, and instruments controlled by the assistants - in each orthognathic surgery section were analyzed and compared between the two groups using repeated-measures factorial analysis of variance (ANOVA). In total, there were 18 participants, comprising both novices (n = 9) and experts (n = 9). For all sections of orthognathic surgery, the percentage of fixation duration on surgical objects was significantly higher for the novices than for the experts (p = 0.031, p = 0.005, p = 0.026, p = 0.047, p = 0.047, p = 0.031, p = 0.027, p = 0.034, p = 0.008, and p = 0.016). During the maxillary segment separation as part of Le Fort I osteotomy and the splitting of the mandible as part of bilateral sagittal split osteotomy, the novices also had a higher percentage of fixation duration on the instruments controlled by the main surgeon, as compared with the experts (p = 0.007 and p = 0.048, respectively). Novices invested great cognitive effort into the surgical objects in each section of orthognathic surgery, including the instruments controlled by the main surgeon in the maxillary segment separation and the splitting of the mandible. Strengthening this aspect of instruction could help novices reduce their cognitive load and achieve mastery more efficiently.

Does Anesthesiologist Experience Influence Early Postoperative Outcomes Following Orthognathic Surgery?

BACKGROUND: Anesthesia provider experience impacts nausea and vomiting in other surgical specialties but its influence within orthognathic surgery remains unclear. PURPOSE: The study purpose was to evaluate whether anesthesiologist experience with orthognathic surgery impacts postoperative outcomes, including nausea, emesis, narcotic use, and perioperative adverse events, for patients undergoing orthognathic surgery. STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study of subjects aged 12 to 35 years old who underwent orthognathic surgery, including Le Fort 1 osteotomy ± bilateral sagittal split osteotomy, at Boston Children's Hospital from August 2018 to January 2022. Subjects were excluded if they had incomplete medical records, a syndromic diagnosis, or a hospital stay of greater than 2 days. PREDICTOR VARIABLE: The predictor variable was attending anesthesia provider experience with orthognathic surgery. Providers were classified as experienced or inexperienced, with experienced providers defined as having anesthetized ≥10 orthognathic operations during the study period. MAIN OUTCOME VARIABLES: The primary outcome variable was postoperative nausea. Secondary outcome variables were emesis, narcotic use in the hospital, and perioperative adverse events within 30 days of their operation. COVARIATES: Study covariates included age, sex, race, comorbidities (body mass index, history of psychiatric illness, cleft lip and/or palate, chronic pain, postoperative nausea/vomiting, gastrointestinal conditions), enhanced recovery after surgery protocol enrollment, and intraoperative factors (operation performed, anesthesia/procedure times, estimated blood loss, intravenous fluid and narcotic administration, and anesthesiologist's years in practice). ANALYSES: χ2 and unpaired t-tests were used to compare primary predictor and covariates against outcome variables. A P-value <.05 was considered significant. RESULTS: There were 118 subjects included in the study after 4 were excluded (51.7% female, mean age 19.1 ± 3.30 years). There were 71 operations performed by 5 experienced anesthesiologists (mean cases/provider 15.4 ± 5.95) and 47 cases by 22 different inexperienced providers (mean cases/provider 1.91 ± 1.16). The nausea rate was 52.1% for experienced providers and 53.2% for inexperienced providers (P = .909). There were no statistically significant associations between anesthesiologist experience and any outcome variable (P > .341). CONCLUSIONS AND RELEVANCE: Anesthesia providers' experience with orthognathic surgery did not significantly influence postoperative nausea, emesis, narcotic use, or perioperative adverse events.

Hemostatic Efficacy of Oxidized Regenerated Cellulose Powder in Le Fort 1 Osteotomy.

A challenging aspect of Le Fort I osteotomy is bleeding control. Osteotomy techniques, devices, drugs, and anesthetic management have been reported to reduce bleeding; however, there are no reports on the use of hemostatic agents. We aimed to evaluate the hemostatic efficacy of a new topical absorbent hemostatic agent, Surgicel Powder, consisting of oxidized regenerated cellulose (ORC). We reviewed the records of 40 patients who underwent Le Fort I surgery for jaw deformities, with or without cleft lip and palate. Twenty of the 40 patients did not have cleft lips or cleft palates (CLCP); the remaining 20 had CLCP. In each group, an absorbent hemostatic agent was used in 10 patients but not in the other 10. Total blood loss and operative time for each group were evaluated. In the jaw deformity without CLCP group, the amount of bleeding with or without ORC was 112.0±33.8 and 158.6±75.3 mL, respectively, with a significant difference between groups ( P <0.05). Operative time with or without ORC was 206.4±31.3 and 238.3±42.5 minutes, respectively, with a significant difference observed between groups ( P <0.05). In the jaw deformity with CLCP group, the amount of bleeding with or without ORC was 199.7±64.6 and 476.8±104.8 mL, respectively, with a significant difference between groups ( P <0.05). Operative time with or without ORC was 213.7±27.6 and 220.8±41.5 minutes, respectively, with no significant difference between groups ( P =0.329). In conclusion, oxidized regenerated cellulose powder may be a beneficial hemostatic agent for reducing blood loss during Le Fort I osteotomy.

[Three-dimensional comparative study on the stability of bimaxillary simultaneous genioplasty and simple genioplasty].

PURPOSE: To establish a three-dimensional method to evaluate whether there is a difference in stability between bimaxillary simultaneous genioplasty and simple genioplasty. METHODS: This study was a retrospective study. Sixty patients who underwent genioplasty were selected. They were divided into bimaxillary simultaneous genioplasty group (n=30) and simple genioplasty group (n=30). The spiral CT data of patients at 2 months before operation (T0), 7 days after operation (T1) and 12 months after operation (T2) were collected, reconstructed and separated, and the three-dimensional model of maxilla and mandible was obtained. A three-dimensional analysis method of stability was established by 3D-matching. Recurrences in three-dimensional space 12 months after surgery were analyzed in two groups of patients. Statistical analysis of the data was performed with SPSS 26.0 software package. RESULTS: In simple genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.54±0.38) mm, and the sagittal recurrence rate was 12.27%. In bimaxillary simultaneous genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.60±0.31) mm, and the sagittal recurrence rate was 12.96%. Rotation occurred in both groups 12 months after operation, which was 1.98±2.70° in the simple genioplasty group and 1.01±1.61° in the bimaxillary simultaneous genioplasty group(P＜0.05). There was no significant difference in the sagittal movement of the chin between the two groups, and in the sagittal recurrence(P＞0.05). CONCLUSIONS: The three-dimensional method established in this study can be used to evaluate the stability after genioplasty. The recurrence after genioplasty mainly occurred in the sagittal direction. The rotation trend of chin after genioplasty is worthy of attention. There was no increased risk for bimaxillary simultaneous genioplasty.

Study of Anatomical Changes of the Inferior Nasal Passage After Le Fort I Osteotomy With Superior Repositioning.

The relationship between postoperative morphological changes in the inferior nasal cavity and inferior turbinate after Le Fort I osteotomy remains unclear. This study aimed to investigate how the bone volume of the inferior turbinate affects contact with the inferior nasal cavity of patients who underwent superior repositioning. We evaluated the 3-dimensional relationship between the anatomical changes in the inferior nasal passage before and after surgery in 51 patients who underwent Le Fort I osteotomy with an elevation of >4.0 mm in the first molar. The soft tissue and bone volumes of the inferior turbinate and airway volume of the inferior nasal passage were calculated using Proplan CMF 3.0 and compared according to the size of the bone volume of the inferior turbinate. In addition, we reclassified the maxillary movements in the pitch direction and compared the results. The contact rates of the postoperative inferior nasal airway and the inferior turbinate in the large-bone group was 72.3% and that in the small-bone group was 40.0% in the χ2 test. The reduction in the inferior nasal passage volume was significantly greater in the large-bone group (pitch+) than in the small-bone group (pitch+). For patients with well-developed bony tissue of the inferior turbinate, caution is advised if the maxillary elevation is ≥4.0 mm, because the possibility of postoperative obstruction of the inferior nasal passages exist, which may lead to deterioration of nasal ventilation.

Horseshoe osteotomy maintains the nasal cavity and function after superior repositioning.

The aim of this prospective cohort study was to compare changes in nasal cavity and function between Le Fort I with and without horseshoe osteotomy after superior repositioning of the maxilla. The patients were divided into 2 groups, a Le Fort I alone (LF alone) group and a combination Le Fort I and horseshoe osteotomy (HS) group. The nasal cavity volume was measured using 3-dimensional computed tomographic images, and nasal resistance was assessed by anterior active mask rhinomanometry. The HS group consisted of 17 patients, and the LF alone group consisted of 15 patients. The magnitude of change in nasal cavity volume was significantly smaller in the HS group than in the LF alone group (p < 0.001), even though the mean amount of superior maxillary movement was considerably larger in the HS group than in the LF alone group (p < 0.001). Mean nasal resistance was significantly smaller postoperatively than preoperatively in the HS group (p < 0.05). Furthermore, the change in nasal resistance was smaller in the HS group than in the LF alone group (p < 0.001). Within the limitations of this study, it seems that horseshoe osteotomy is useful for maintaining the nasal cavity and function after superior repositioning of the maxilla.

Factors affecting progressive facial swelling immediately after orthognathic surgery: A retrospective cohort study.

The aim of this study was to identify clinical factors associated with progressive facial swelling after orthognathic surgery. Patients diagnosed with jaw deformities and undergoing orthognathic surgery were retrospectively evaluated, and those with surgical site infection, Le Fort I osteotomy, or genioplasty only were excluded. Facial swelling volume was calculated by comparing facial volume preoperatively and three days postoperatively using 3D images and image analysis software (VECTRA H2). FXIII was measured within three days after surgery in only patients with unexplained postoperative bleeding or hematoma. The correlation between facial swelling volume and clinical factors was statistically analyzed. Facial swelling volume was examined in 78 patients. Univariate analysis showed a significant difference between facial swelling volume (mean = 41.6 cm3) and operation time (mean = 209.3 min, r = 0.283, p = 0.012), ΔHb level (mean = 1.18 g/dL, r = 0.235, p = 0.039), as well as decreased factor XIII activity (mean = 75.3%, p = 0.012). Multivariate analysis showed a significant difference between facial swelling volume and FXIII deficiency (standard error = 6.44, p = 0.031).Progressive facial swelling immediately after orthognathic surgery may be due to factor XIII deficiency.

Evaluation of soft tissue changes around the nose following subspinal Le Fort â osteotomy.

PURPOSE: This study sought to evaluate the effect of subspinal Le Fort Ⅰ osteotomy (SLFⅠO) and alar base chinch suture (ABCS) in preventing postoperative changes of nasal shape following maxillary movement of advancement-impaction (MAI) or advancement-downward (MAD) by analyzing changes of nasal soft tissue on computed tomography (CT) images. METHODS: Forty-three Japanese patients with dentofacial deformity who underwent orthognathic surgery with SLFⅠO and ABCS were retrospectively examined. Maxillary movement and changes to soft tissues around the nose were analyzed using pre- and postoperative CT. RESULTS: Increased nasal width and alar base width, upturning of the nasal tip and flattening of the nose occurred in both groups, with more prominent changes in MAI. MAD showed horizontal maxillary movement strongly correlated with changes in pronasale and subnasale. Preoperative nasal height correlated negatively with changes to nasal height in both groups, and to nasolabial angle and nasal tip angle in MAD. There were no correlations between the tightness of ABCS during operation and postoperative nasal soft tissue changes including nasal width. CONCLUSION: Postoperative changes to nasal shape following SLFⅠO and ABCS need to be considered with advance movements of the maxilla, regardless of vertical maxillary movement. Postoperative pronasale and subnasale may be estimable from the amount of the maxillary advance movement in MAD. Postoperative changes in nasal shape may be more prominent in cases with low nasal height.

Postoperative stability of bioresorbable plates made of 85:15 poly (L-lactide-co-glycolide) in Le Fort I osteotomy.

OBJECTIVE: Recently, RapidSorb plates (DePuy Synthes) made of 85.15 poly (L-lactide-co-glycolide) have been used for orthognathic surgery; however, reports regarding their effectiveness are limited. We aimed to compare the postoperative stability of RapidSorb plates, RapidSorb combined with titanium (MOJ plates), and MOJ plates in patients who underwent Le Fort I osteotomy at Tokyo Medical and Dental University Hospital. STUDY DESIGN: The use of RapidSorb in the maxilla is a load-sharing application and therefore constitutes an approved indication. Discrepancies in the maxillary positions were measured using postoperative computed tomography data at 1 week and 1 year using the centroid method 3-dimensionally. Treatment with RapidSorb alone showed a more vertical discrepancy in the maxilla treatment with MOJ and RapidSorb+MOJ. The RapidSorb4 group was subdivided into 2 groups (under and over 1.0-mm) based on the change in the maxillary centroid. RESULTS: The bone gap at the lateral border of the piriform aperture was significantly larger in the over-1.0-mm group than in the 1.0-mm group. CONCLUSIONS: The fixation of RapidSorb alone is not appropriate in load-bearing and unstable applications but is not contraindicated for load-sharing indications. Fixation with RapidSorb combined with MOJ was clinically effective, with results similar to titanium plate-only fixation regarding postoperative stability.

Incidence of Otalgia After Orthognathic Surgery.

BACKGROUND: In orthognathic surgery, it is well known that maxillary osteotomies and displacements sometimes affect auditory function. Thus, this study examined the relationship between the direction of maxillary displacement and postoperative otalgia. METHODS: Twenty consecutive patients underwent Le Fort I maxillary osteotomy using advancement, impaction, setback, or a combination of these procedures. The direction of movement and incidence of otalgia were investigated. Patients provided informed consent preoperatively, and postoperative reassurance was prudent. RESULTS: Pure-tone average evaluation based on horizontal or vertical movements did not show significant differences, although vertical movements resulted in fewer changes in the hearing threshold. Specifically, no significant changes were observed in the hearing thresholds of patients after surgery. No significant difference was also observed between horizontal and vertical movements in the tympanometry results. Negative changes were found in the results of the Eustachian tube dysfunction test in vertical movements, which returned to preoperative values in the final test. CONCLUSIONS: The risk of minor changes in hearing function is probable during the first week after orthognathic surgery; however, these negative changes either completely disappear or remain negligible.

[Effect of alar base cinch suture based on anatomic landmarks on the morphology of nasolabial region in patients after orthognathic surgery].

OBJECTIVE: To study the effect of a modified alar base cinch suture (ABCS) based on nasal musculature anatomy on the three-dimensional morphology of nasolabial region in patients after Le Fort Ⅰ osteotomy. METHODS: In the study, 30 patients[11 males and 19 females, with an average age of (23.23±2.98) years]with skeletal Class Ⅲ malocclusion underwent orthognathic surgery between August, 2019 and January, 2020 to have the maxilla advanced no more than 4 mm in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were involved and were divided into the test and control groups based on the random number table.In the test group, the nasal musculature was identified and labeled before dissection and the ABCS was according to the label, while in the control group, the nasal musculature was directly sutured and knotted in the midline of nose without prepend labeling.All the patients underwent three-dimensional facial photos preoperatively and 6 months postoperatively by using 3dMD face system.On the three dimensional image, soft tissue landmarks of nasolabial region was identified by the same examiner.Fourteen measurements including straight distance, curve distance, angle and ratio were measured.Statistical analysis was done by using SPSS 22.0. RESULTS: There were significant differences between the two groups in cutaneous height of upper lip (P=0.023) and in nasal tip protrusion-alar width (P=0.012).The increase rate of cutaneous height of upper lip and the decrease rate of nasal tip protrusion-alar width in the control group were significantly higher than that in the test group.The alar width and alar base width of the both groups were significantly increased compared with the preoperative level (P < 0.05).The nasolabial angle in the control group was significantly higher compared with the normal value, while there was no significant difference between the test group and the normal value. CONCLUSION: Compared with the conventional suture method, this modified alar base cinch suture is more favorable for the postoperative nasal coordination and nasolabial morphology in patients who need mild to moderate maxillary advancement, and it has certain advantages in operability and objective accuracy.So it could become a modified and accurate method of alar base cinch suture and be widely applied in clinical practice.

Stability of Le Fort 1 osteotomy in patients with bilateral cleft lip and palate: A retrospective study of 71 patients.

The aim of this study was to evaluate the sagittal and vertical relapses after Le Fort 1 osteotomy in bilateral cleft lip and palate (BCLP) patients. Lateral cephalograms before surgery, immediately after the procedure, at one year, and at least two years (when available) after surgery were superimposed. The positions of five landmarks were studied in a coordinate system. Uni- and multivariate analyses investigated the effect of various factors on the relapse. Of the 71 patients included for a BCLP, 54 presented complete data at one year, and 30 patients were included for the long follow-up study (mean of 55 months). The mean maxillary advancement was 6.2 mm on the sub-spinal point (A). Sagittal relapse occurred at one year (mean of 1.1 mm on point A, 0.7 mm on point prosthion (P); p < 0.0001) and progressed by 0.5 mm and 1.0 mm, respectively, on the same points at the last follow-up. The mean vertical relapse was 0.5 mm on point A (p = 0.044), 0.6 mm on point P (p = 0.16) and 0.5 mm on incisor (I) (p = 0.056). The vertical relapse was correlated to the degree of vertical movement. Three factors were associated to the recurrence including a prior pharyngeal flap, an associated mandibular osteotomy and smoking habits.