A prospective study of soft- and hard-tissue changes after mandibular advancement surgery: Midline changes in the chin area.

INTRODUCTION: The purpose of this research was to prospectively determine the ratio of 2 soft-tissue landmarks, pogonion (sPg) and menton (sMe), to their hard-tissue counterparts (Pg and Me) in the sagittal and vertical directions for mandibular lengthening surgeries. METHODS: We drew a sample from the prospective Orthognathic and Orthofacial Surgery Research study, consisting of patients who underwent surgical mandibular lengthening (alone or in combination with maxillary osteotomy) without genioplasty. We digitized landmarks using Facewizz software and determined the relationships between the hard- and soft-tissue changes by correlation analysis. RESULTS: Pearson correlation test showed a significant correlation between the type of surgery and the sPg:Pg and sMe:Me ratios. The sPg:Pg ratio was 87% for mandibular lengthening only and 102% for mandibular lengthening in combination with maxillary surgery. The sMe:Me ratio was 85% and 96% for upward and downward movements, respectively. CONCLUSIONS: The average ratios presented in this study for the pogonion and menton can aid in preoperative planning by providing estimates for soft-tissue behavior. Further stratifications will be possible after the Orthognathic and Orthofacial Surgery Research database is enriched with more inclusions.

Postoperative Physiotherapy After Open Temporomandibular Joint Surgery: A 3-Step Program.

PURPOSE: This study aimed to ascertain the value of postoperative physiotherapy after open temporomandibular joint (TMJ) surgery and provide a usable approach for practitioners. MATERIALS AND METHODS: The authors performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of literature concerning the results of postoperative physiotherapy after open TMJ surgery to evaluate its effect on rehabilitation. PubMed Central, Web of Science, Cochrane Library Plus, CINAHL, and EMBASE were used to conduct this search and all articles up to April 1, 2018 (total, 675 articles) were included. Risk of bias in nonrandomized controlled trials (non-RCTs) and other observational studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) scale. The Cochrane Collaboration's tool was used for evaluating RCTs. Maximal mouth opening (MMO) before and after surgery was evaluated, as was the physiotherapeutic protocol used during the postoperative period. Evaluation of lateral movement and pain also was included, if this information was provided. RESULTS: Initially, 675 articles were found, 6 of which were included after screening. Risk of bias was found to be unclear in the included RCTs and rather high in comparative and noncomparative articles. Three studies concluded that patients who received postoperative physiotherapy had a significantly larger increase in MMO (P < .05) compared with patients who did not receive any postoperative physiotherapy. No difference in lateral movement was found (P > .05). Mean visual analog scale pain score was significantly lower in patients who were treated with physiotherapy according to 2 of the included articles (P < .05). CONCLUSIONS: Based on the current scientific literature included in this systematic review, it can be concluded physiotherapy after open TMJ surgery plays an important role in achieving good postoperative results. The authors provide a scheme for its effective use.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair.

OBJECTIVE: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. DESIGN: Systematic review. SETTING: Various primary cleft and craniofacial centers in the world. PATIENTS, PARTICIPANTS: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. INTERVENTION: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. OUTCOME: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. RESULTS: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate-hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. CONCLUSION: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

Transverse Maxillary Development in Complete Cleft Patients: Comparison of 2 Treatment Strategies by Longitudinal and Cross-Sectional Model Analysis.

OBJECTIVE: This study aimed to compare differences in the maxillary transverse dimension following cleft repair using 2 protocols involving a 2-staged palatal closure with similar timing but different techniques. DESIGN: Retrospective study. Two matched study samples, each containing 10 patients. SETTING: Cleft center A is a university hospital. Cleft Center B is a general teaching hospital. PATIENTS: Patients with cleft lip alveolus and palate (CLAP) were matched by cleft type, gender, age, and palatal morphology at the age of 1 month. Differences in the transverse dimension were measured at 4 ages in 2 matched groups (A and B from center A and B), each including 5 patients with unilateral CLAP (UCLAP) and 5 patients with bilateral CLAP (BCLAP). INTERVENTIONS: Orthodontic/orthopedic expansion treatment began at 8 and 5 years of age at centers A and B, respectively. RESULTS: The mean intercanine distance decreased by 8 mm (standard deviation [SD] = 1.6; P = .030) in group A patients with UCLAP between 1 and 5 years (SD = 1.6; P = .030) and by 6.3 mm (SD = 3.2; P = .016) in group B patients with BCLAP. The mean intermolar distance increased by 4 mm (SD = 3.4; P = .076) in patients with BCLAP. A trend toward improved canine positioning was observed in patients with BCLAP by 12 years of age, with improvement occurring between 4 and 12 years. CONCLUSION: The type of palatal closure (inducing scar tissue at the bony level) and the late installment of orthodontic/orthopedic expansion probably reduced the intercanine width in bilateral complete clefts.

Early Complications From the Use of Calcium Phosphate Paste in Mandibular Lengthening Surgery. A Retrospective Study.

PURPOSE: Calcium phosphate paste is used in mandibular lengthening surgery to avoid unesthetic notching at the lower border and to help stabilize the segments when osteosynthesis slippage is a concern. The aim of this study was to investigate whether the hardened paste increases the incidence of infections. MATERIALS AND METHODS: This was a retrospective cohort study of medical charts of all patients who underwent a bilateral sagittal split osteotomy from February 2012 through July 2015. The outcome and predictor variables were postoperative infection and calcium phosphate paste use, respectively. Other study variables included age, gender, tobacco use, type of fixation, type of surgery, antibiotic prophylaxis regimen, third molar extraction, and medical comorbidities. Variables were analyzed using the Fisher exact test and logistic regression. RESULTS: The sample included 196 patients (115 female and 81 male) 9 to 57 years old. The overall infection rate was 12.2%. Of the 102 patients who received calcium phosphate paste, 18.6% developed an infection compared with 5.3% in the control group. The difference in infection rate was statistically significant (odds ratio = 0.14; 95% confidence interval [CI], 0.04-0.48; P = .002) after adjusting for the other variables. Of the 392 surgical sites, 204 had received calcium phosphate paste, of which 10.3% became infected. Of the 188 sites without defect reconstruction, 6 (3.2%) became infected (P = .008 by bivariate analysis). There was a statistically significant association between third molar removal and infections (odds ratio = 8.01; 95% CI, 1.28-50.1; P = .026) and between the use of amoxicillin plus clavulanate and the use of cefazolin (odds ratio = 3.92; 95% CI, 0.87-17.63; P = .07). CONCLUSION: There was a relevant trend of increased infection with calcium phosphate paste use. Third molar removal also was identified as a risk factor. Prospective studies after procedural modifications are recommended to determine whether the benefits of using calcium phosphate paste outweigh the risks.

Suture Autotransplantation and Dural Stripping for Craniosynostosis: A Long-Term Growth Study in Humans.

OBJECTIVE: Craniosynostosis treatment by suture autotransplantation and dura stripping has proven to be successful in animals. When applied clinically, it may reduce operative morbidity and postoperative growth disturbances known to occur after radical remodeling. It may prevent resynostosis, which is known to occur after simple synostostectomy. It may prevent subcutaneous fluid collections known to occur after synostectomy and dura stripping. STUDY DESIGN: Four synostostic infants have been treated using this concept and followed up by computerized scans. The distance between markers on each side of the transplanted sutures (6 in total) has been monitored from 1.5 to 7 years. RESULTS: The transplanted suture areas remained intact, and the sutures remained patent and experienced growth. A fifth patient with similar results was published earlier as a case report. CONCLUSIONS: Suture transplantation and dural stripping should be further studied in future multicenter studies with larger series, comprising syndromic and nonsyndromic synostosis patients.

Classification of Computer-Aided Design-Computer-Aided Manufacturing Applications for the Reconstruction of Cranio-Maxillo-Facial Defects.

PURPOSE: To gain insight into the methodology of different computer-aided design-computer-aided manufacturing (CAD-CAM) applications for the reconstruction of cranio-maxillo-facial (CMF) defects. METHODS: We reviewed and analyzed the available literature pertaining to CAD-CAM for use in CMF reconstruction. RESULTS: We proposed a classification system of the techniques of implant and cutting, drilling, and/or guiding template design and manufacturing. The system consisted of 4 classes (I-IV). These classes combine techniques used for both the implant and template to most accurately describe the methodology used. CONCLUSIONS: Our classification system can be widely applied. It should facilitate communication and immediate understanding of the methodology of CAD-CAM applications for the reconstruction of CMF defects.

Options for the nasal repair of non-syndromic unilateral Tessier no. 2 and 3 facial clefts.

BACKGROUND: Non-syndromic Tessier no. 2 and 3 facial clefts primarily affect the nasal complex. The anatomy of such clefts is such that the ala of the nose has a cleft. Repairing the ala presents some challenges to the surgeon, especially to correct the shape and missing tissue. Various techniques have been considered to repair these cleft defects. AIM: We present two surgical options to repair such facial clefts. MATERIALS AND METHODS: A nasal dorsum rotational flap was used to treat patients with Tessier no. 2 clefts. This is a local flap that uses tissue from the dorsal surface of the nose. The advantage of this flap design is that it helps move the displaced ala of a Tessier no. 2 cleft into its normal position. A forehead-eyelid-nasal transposition flap design was used to treat patients with Tessier no. 3 clefts. This flap design includes three prongs that are rotated downward. A forehead flap is rotated into the area above the eyelid, the flap from above the eyelid is rotated to infra-orbital area and the flap from the infraorbital area that includes the free nasal ala of the cleft is rotated into place. RESULTS AND CONCLUSIONS: These two flap designs show good results and can be used to augment the treatment options for repairing Tessier no. 2 and 3 facial clefts.

The ideal shape of the female jaw angle: An online survey.

The aim of this study was to determine the characteristics of an attractive white female jaw angle in the three dimensions. An online survey of photographs of celebrities and laypeople was used to rate their attractiveness using 6 questions and a 3-item Likert scale. If ≥ 80% of participants rated a model as having attractive aesthetic features, it was considered attractive. The following features were considered important: a gonial angle in profile of 125.5° and in anterior view of 142°, an intergonial-interzygomatic width ratio of 0.83 and the vertical position of the jaw angles at the level of the stomion or upper lip. Surgeons can use these consensus criteria to help design a jaw angle implant, define orthognathic surgical strategies, or shape the angle using injectables.

Prevention and non-surgical treatment of soft tissue polly beak deformity after rhinoplasty: a scoping review.

The aim of this study is to map the available evidence of surgical preventive measures and postoperative methods for addressing supratip fibrosis (polly beak deformity) following rhinoplasty, to describe the postoperative results and to identify the most effective techniques. A scoping review was performed, selecting articles from the following medical electronic databases: PubMed, Cochrane Central, EMBASE, and Web of Science up to October 2022. The following keywords were used: supratip fullness, supratip deformity, polly beak deformity and supratip fibrosis. A total of 19 studies met the eligibility criteria. Of these 18 were included, and were divided into two categories: studies that solely used non-surgical management and studies that used operative techniques to prevent soft tissue polly beak deformity. Cartilaginous causes of polly beak deformity were excluded. Although a number of different methods are described in literature, the effectiveness and potential of each are still open to debate. Randomized controlled trials that use a standardized objective measurement method for soft tissue polly beak deformity are needed to objectively compare different methods.

Patient Satisfaction and Impact on Oral Health after Maxillary Rehabilitation Using a Personalized Additively Manufactured Subperiosteal Jaw Implant (AMSJI).

Subperiosteal implants (SIs) were first developed by Dahl in 1941 for oral rehabilitation in case of severe jaw atrophy. Over time, this technique was abandoned due to the high success rate of endosseous implants. The emergence of patient-specific implants and modern dentistry allowed a revisitation of this 80-year-old concept resulting in a novel "high-tech" SI implant. This study evaluates the clinical outcomes in forty patients after maxillary rehabilitation with an additively manufactured subperiosteal jaw implant (AMSJI®). The oral health impact profile-14 (OHIP-14) and numerical rating (NRS) scale were used to assess patient satisfaction and evaluate oral health. In total, fifteen men (mean age: 64.62 years, SD ± 6.75 years) and twenty-five women (mean age: 65.24 years, SD ± 6.77 years) were included, with a mean follow-up time of 917 days (SD ± 306.89 days) after AMSJI installation. Patients reported a mean OHIP-14 of 4.20 (SD ± 7.10) and a mean overall satisfaction based on the NRS of 52.25 (SD ± 4.00). Prosthetic rehabilitation was achieved in all patients. AMSJI is a valuable treatment option for patients with extreme jaw atrophy. Patients enjoy treatment benefits resulting in high patient satisfaction rates and impact on oral health.

Soft tissue response and determination of underlying risk drivers for recession and mucositis after AMSJI implantation in the maxilla.

PURPOSE: There are few treatment options for oral rehabilitation in patients with advanced maxillary resorption (Cawood-Howell Class V or more). Patient-specific, 3D-printed titanium subperiosteal implants have been described as a potentially valuable alternative solution. Surgeon and patient mediated functional outcomes have been studied and the results are promising. The surrounding soft tissue health has been much less researched. This study aims to evaluate the soft tissue response to the placement of additively manufactured subperiosteal jaw implants (AMSJI®) in the severely atrophic maxilla and to identify possible risk factors for soft tissue breakdown. MATERIALS AND METHODS: An international multicenter study was conducted and fifteen men (mean age 64.62 years, SD ± 6.75) and twenty-five women (mean age 65.24 years, SD ± 6.77) with advanced maxillary jaw resorption (Cawood-Howell Class V or more) were included in this study. General patient data were collected and all subjects were clinically examined. Inclusion criteria were patients who underwent bilateral AMSJI placement® in the maxilla at least a year before and whose surgeon and themselves agreed to participate in the study before their inclusion. RESULTS: A total of forty patients were enrolled with a mean follow-up period of 917 days (SD ± 306.89 days). Primary stability of the implant was achieved postoperatively in all cases, and all implants were loaded with a final prosthesis. At the time of study, only one patient showed mobility of the bilateral AMSJI (more than 1 mm). Exposure of the framework, due to mucosal recession, was seen in 26 patients (65%) and was mainly in the left (21.43%) and right (18.57%) mid-lateral region. Thin biotype and the presence of mucositis were found to be risk factors (p-value < 0.05). Although not significant, smokers had a nearly seven times (Odds ratio 6.88, p=0.08) more risk of developing a recession compared to nonsmokers. CONCLUSION: Twenty-six (65%) patients presented with a recession in one or (more) of the seven regions after oral rehabilitation with bilateral AMSJI installation. Several risk drivers were evaluated. The collapse of soft tissues around the AMSJI that led to caudal exposure of the arms was correlated with a thin biotype and the presence of mucositis.

On the use of intraoperative 3D-RX C-arm imaging in orthognathic surgery: a prospective non-consecutive case series study.

CONTEXT: Segment and osteosynthesis malposition resulting in patients' complaints (mainly about asymmetries) are encountered in orthofacial/orthognathic surgery. OBJECTIVE, DESIGN, AND SETTING: We planned to investigate the usefulness of intraoperative three-dimensional (3D) imaging concerning positioning and fixation of bone segments and osteosynthesis in orthognathic/orthofacial surgery. We performed a prospective study of non-consecutive cases. All patients receiving a bimaxillary osteotomy, genioplasty, and their combinations were included in the study from May 2016 to May 2020. Unilateral and bilateral sagittal split osteotomies were excluded. There were no gender and age limitations. All were intraoperatively examined using the BV Pulsera 3D-RX System (Philips Medical, Eindhoven, The Netherlands). The outcome variables were the percentage of revisions of segment positioning and osteosynthesis. Predictor variables were age, gender, type of surgery, timing (pre- and post-imaging), and surgeon experience (senior vs assistant). RESULTS: Forty female and twenty-two male patients were included (mean age 25.25 years ± 7.52 and 29.1 years ± 12.6 respectively). We evaluated 27 genioplasties and 34 Le Fort "type-I" osteotomies. Indications for segment repositioning and redo-osteosynthesis increased after intraoperative imaging as compared to operator's clinical judgment before intraoperative imaging (95% confidence interval; p < .001 and p = .002 respectively). CONCLUSION: Suboptimal positioning and fixation of bone segments or osteosynthesis were more apparent with 3D imaging. In addition, some satisfactory cases were also revised for an optimal outcome. As a result, surgeons were prompted to more revisions than judged necessary without intraoperative imaging.

Obstacles for accessing customised craniofacial implants in low- and middle-income countries.

INTRODUCTION: Many low resourced low- and middle-income countries (LMICs) do not have access to (high tech) developments in the medical field. The aim of this study is to research how a contemporary high-tech solution, such as customized medical implants, can be transferred to low resource LMICs. MATERIALS AND METHODS: We explored the internet to retrieve data regarding internet coverage, services providing free email accounts, and the availability of connecting devices. Additionally, a computerized search was performed for currently available PSI concepts and other important emerging technologies with potential value in craniomaxillofacial surgery. Lastly, we searched the internet for the availability of CT scan devices and smartphones in the LMICs. RESULTS: Internet penetration and access to computers/smartphones is low in the LMIC's. Moreover, availability of radiology departments and radiologist is very limited (60 radiologist per 190 million Nigerian inhabitants) and a lack of knowledge concerning import regulations and customs clearance, limit the accessibility/availability for patient-specific implants, since this is crucial in developing and delivering these devices. Lastly, appropriate training and instrumentation is vital (yet, currently difficult) to acquire and foresee, in order to achieve the best post-operative results. CONCLUSION: This research confirms great difficulties achieving our aims but with persistence and adoption of well-constructed programs it should be possible.

How surface coatings on titanium implants affect keratinized tissue: A systematic review.

Apart from osseointegration, the stability and long-term survival of percutaneous titanium implants is also strongly dependent on a qualitative soft-tissue integration in the transcutaneous region. A firm connective tissue seal is needed to minimize soft-tissue dehiscence and epithelial downgrowth. It is well-known that the implant surface plays a key role in controlling the biological response of the surrounding keratinized tissue and several coating systems have been suggested to enhance the soft-tissue cell interactions. Although some promising results have been obtained in vitro, their clinical significance can be debated. Therefore, the purpose of this systematic review is to gain more insight into the effect of such coatings on the interface formed with keratinized soft-tissue in vivo. A comprehensive search was undertaken in March 2021. Relevant electronic databases were consulted to identify appropriate studies using a set of search strings. In total, 12 out of 4971 publications were included in this review. The reported coating systems were assigned to several subgroups according to their characteristics: metallic, ceramic and composite. Notwithstanding the differences in study characteristics (animal model, implantation period, reported outcomes), it was noticed that several coatings improve the soft-tissue integration as compared to pristine titanium. Porous titanium coatings having only limited pore sizes (<250 µm) do not support dermal fibroblast tissue attachment. Yet, larger pores (>700 µm) allow extensive vascularized soft-tissue infiltration, thereby supporting cell attachment. Nanostructured ceramic coatings are found to reduce the inflammatory response in favor of the formation of cell adhesive structures, that is, hemidesmosomes. Biomolecule coatings seem of particular interest to stimulate the soft-tissue behavior provided that a durable fixation to the implant surface can be ensured. In this respect, fibroblast growth factor-2 entrapped in a biomimetic apatite coating instigates a close to natural soft-tissue attachment with epidermal collagen fibers attaching almost perpendicular to the implant surface. However, several studies had limitations with respect to coating characterization and detailed soft-tissue analysis, small sample size and short implantation periods. To date, robust and long-term in vivo studies are still lacking. Further investigation is required before a clear consensus on the optimal coating system allowing enhancing the soft-tissue seal around percutaneous titanium implants can be reached.

Surface wear in a custom manufactured temporomandibular joint prosthesis.

The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti6 Al4 V) mandibular condyle and glenoid fossa created through selective laser melting, with a machined vitamin E-enriched ultra-high molecular weight polyethylene (UHMWPE) surface attached to the fossa. Thirteen TMJ prosthesis were implanted in sheep, six of which had condylar heads coated with HadSat® diamond-like carbon (H-DLC). Euthanasia took place after 288 days, equaling 22 years of human mastication. Linear and volumetric wear analysis of the fossa was performed by optical scanning. The condylar head surfaces were assessed by scanning electron and confocal laser microscopy. The average linear UHMWPE wear, when combined with the coated condyle, was 0.67 ± 0.28 mm (range: 0.34-1.15 mm), not significantly differing (p = .3765, t-test) from the non-coated combination average (0.88 ± 0.41 mm; range: 0.28-1.48 mm). The respective mean volumetric wear volumes were 25.29 ± 11.43 mm3 and 45.85 ± 22.01 mm3 , not significantly differing (p = .1448, t-test). Analysis of the coated condylar surface produced a mean Ra of 0.12 ± 0.04 µm and Sa of 0.69 ± 0.07 µm. The non-coated condylar surface measured a mean Ra of 0.28 ± 0.17 µm and Sa of 2.40 ± 2.08 µm. Both Sa (p = .0083, Mann-Whitney U test) and Ra (p = .0182, Mann-Whitney U test), differed significantly. The prosthesis exhibits acceptable wear resistance and addition of the H-DLC-coating significantly improved long-term condylar surface smoothness.

Postoperative wound management after cleft lip surgery.

OBJECTIVE: Our aim was to describe the postoperative management and wound care protocol after primary cleft lip closure, as it has been used in the Bruges Cleft and Craniofacial Center at the supraregional teaching hospital AZ St. Jan, Bruges, between June 1, 1991, and July 1, 2009. MATERIALS: The postoperative management and wound care included the use of a Logan bow, long-acting local anesthetic, elbow restraints, antibiotic therapy, crust removal with normal saline solution, and a special local wound ointment that was prepared at our center. RESULTS: During the last 19 years, 199 unilateral and 103 bilateral cleft lip patients have been repaired. 2.6% showed postoperative infection and/or dehiscence. One percent required readmission for reoperation. In 1.6%, inflammatory reaction was treated with oral antibiotics. CONCLUSION: The specific wound dressing ointment, as it is prepared in our department, could meet the requirements of primary wound management after cleft lip closure.

Need for velopharyngeal surgery after primary palatoplasty in cleft patients. A retrospective cohort study and review of literature.

BACKGROUND: Enabling intelligible speech plays an important role in achieving social inclusion and a good quality of life of cleft patients. A crude measure of primary palatal repair quality is the incidence of operations to correct velopharyngeal insufficiency (VPI) after speech-language therapy has proven inadequate. This study assessed the necessity for surgery to correct velopharyngeal insufficiency following our standardized two-staged protocol, compared the results with the literature, and identified factors that may influence velopharyngeal competence. METHODS: A review of the literature was performed. The outcome measure in our series was the necessity for a secondary procedure to correct velopharyngeal insufficiency. The results of literature review were compared with the results of our case series, which we treated using a standardized protocol. RESULTS: In our retrospective study, 5 patients (2.5%) required secondary pharyngoplasty. In literature, the frequency of surgery to correct velopharyngeal insufficiency after one- and two-stage protocols were 13.6% and 24.5%, respectively. No statistical difference was found between bilateral and unilateral clefts. The frequencies of velopharyngeal surgery were 7.2% after Furlow palatoplasty, 17.5% after a 2-flap palatoplasty, 18.6% after a Wardill-Killner palatoplasty, and 35.6% after a Von Langenbeck palatoplasty. CONCLUSION: The literature reported that one-stage palatoplasty is correlated with a lower incidence of secondary pharyngeal surgery. Our standardized two-stage protocol proved successful in avoiding secondary velopharyngeal surgery but due to the reduced number of patients included in our study, more research is needed.

Third-generation slotplates for orthognathic and facial corrective surgery.

The aim of this study was to retrospectively assess the osteosynthesis material-related morbidity rates of third-generation (3.0) slotplates, and to compare those with the previously researched second-generation (2.0) slotplates. In the 2.0 slotplate design, there were additional tabs in line with the vertical slotted screw hole; in between these tabs, the additional locking screw was placed. In the 3.0 slotplates, these tabs were replaced by a full screw hole for the locking screw, and the 3.0 slotplates are slightly broader than the 2.0 slotplates. Osteosynthesis material-related morbidity rates after Le Fort I-type, zygoma-valgisation, and chin osteotomies were assessed in a cohort receiving 3.0 slotplates in a tertiary care centre and compared to a previously analysed cohort receiving 2.0 slotplates in the same tertiary care centre. Medical records of 77 patients (101 surgeries) receiving 3.0 slotplates were reviewed. Plate infection and plate removal rates were low in the 3.0 slotplate group (2.6% (p = 0.123) and 3.9% (p = 0.103), respectively). No delayed union or non-union occurred in the 3.0 slotplate group. Comparing the morbidity rates with the 2.0 slotplate cohort did not yield any significant differences. Although there was a tendency towards better outcomes with 3.0 slotplates compared to the 2.0 slotplates, the outcome differences did not reach statistical significance.

Evaluation of Patient-Specific Cranial Implant Design Using Finite Element Analysis.

BACKGROUND: Various studies have investigated the load-bearing capacity of patient-specific cranial implants. However, little attention has been given to the evaluation of the design of ceramic-titanium (CeTi) implants. METHODS: A biomechanical evaluation of 3 patient-specific cranial implants was performed using finite element analysis. RESULTS: The results of the analyses allowed the identification of the implant regions as well as the magnitudes of the maximum stresses on, and displacements along, these regions after traumatic impact. The analyses also showed that polyether ether ketone cranial implants offer inferior brain and neurocranial protection due to their high flexibility and local peak stresses at the bone-screw interface. In contrast, CeTi implants were able to evenly distribute the stresses along the interface and thus reduced the risk of neurocranial fracture. The scaffold structure at the border of these implants reduced stress shielding and enhanced bone ingrowth. Moreover, brain injuries were less likely to occur, as the CeTi implant exhibits limited deflection. CONCLUSIONS: From the finite element analyses, CeTi cranial implants appear less likely to induce calvarial fractures with a better potential to protect the brain under impact loads.