Orthognathic surgery

Class II skeletal base with vertical maxillary excess (VME) and skeletal mandibular deficiency presents a combination of several problems about function, psychology, and esthetics. The optimal treatment plan generally includes a harmonized orthodontic-surgical approach through superior repositioning (Vertical maxillary impaction) using Le-Fort I osteotomy, mandibular advancement, and genioplasty. A 23-year-old woman with severe skeletal Class II malocclusion, convex profile, and gummy smile was referred to our department. Skeletally, she presented with vertical maxillary excess, mandibular deficiency along with a hyperdivergent growth pattern. Dentally, Class II molar, and canine relationships increased overjet and overbite with proclined upper (U1-SN: 118o) and lower incisors (L1-MP: 97o). Maxillary impaction was planned to correct the gummy smile, and mandibular advancement to improve the convex profile and correct the mandibular deficiency. In adjunct, genioplasty was also planned to correct the chin deficiency. The decompensation phase involved correction of the proclination and crowding of the upper incisors by extraction of the upper first premolars and decrowding, uprighting, and retracting the lower incisors by using the molar extraction space thus increasing the overjet. Bi-jaw surgery which included a Le-fort I osteotomy for vertical maxillary impaction (4mm), bilateral sagittal split osteotomy (BSSO) for mandibular advancement (5mm), and genioplasty was done to correct the skeletal and dental Class II. This case report describes a multidisciplinary approach in the successful management of a patient with VME and mandibular advancement to achieve superior function, stability, facial esthetics, and an ideal occlusion.

This prospective comparative clinical trial study aims to investigate the postoperative stability of the double-jaw surgical treatment of skeletal Class III deformity and to compare two different mandibular surgical approaches. The study goal is to locate the relapsing direction of both the maxilla and the distal segment after either bilateral sagittal split ramus osteotomy (BSSO), or intraoral vertical ramus osteotomy (IVRO). Twenty-two (22) patients with skeletal Class III were included in this study. The patients were treated with double-jaw surgery by LeFort I osteotomy combined with either BSSO or IVRO. Lateral cephalograms taken before (T0), immediately after (T1), and 1 year after the surgery (T2) were studied and analyzed. The mean mandibular setback and maxillary advancement in the BSSO group were 6.22 mm at B Point and 2.93 mm at A point with relapse percentages of 24.9 and 26.6%, respectively, while the mean mandibular setback and maxillary advancement in the IVRO group were 2.55 mm at B point and 5.89 mm at A point with relapse percentages of 22.1 and 23.5%, respectively. The magnitude of the setback significantly accounted for the relapse. One-year follow-up revealed that the maxilla would be displaced posteriorly and inferiorly in both groups. Regarding the direction of the mandibular relapse, the mandible in BSSO surgical group was displaced forward and upward, while in IVRO surgical group, the directions were completely different in which the mandible is displaced backward and downward.

Orthognathic surgery involves correction of functional and often esthetic disharmonies. The purpose of this case report is to present the case of a 22 years-old female with class III dentofacial deformity that required orthognathic surgery to treat her malocclusion and buccal fat pad excision for optimizing soft-tissue facial contour. Treatment planning involved a counterclockwise rotation of the maxilomandibular complex with genioplasty based on digital 3D surgical planning using the Dolphin Imaging ® 11.7 3D Premium software. Prototyping splints allowed surgical procedures (bilateral sagital mandibular osteotomy associated to a Le fort I osteotomy) that corrected position of the gnathic bones. In the same surgical procedure, the buccal fat pad was partially removed for a sharp cheek contour giving a slimmer appearance to her face. After 5 months, the patient was reassessed and reported no complaints regarding esthetics or function. This case illustrates that a combination of orthognathic surgery and an esthetic procedure can result in a stable and harmonious facial as well as occlusal outcomes.

Clinical management of non-growing adult patients with
dentofacial deformity could be provided with better
outcome when approach in-combined with orthodontic
and orthognathic surgery than that of single approach
alone. This study describes a case of a 26years old
Bangladeshi female presented with bimaxillary protrusion
treated with the combination of orthodontic and
orthognathic surgery.

Objectives We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published. Method A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea. Results Bulk of the studies were retrospective, and less interest was shown onto experimental researches. Conclusion A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.

Orthognathic surgery leads to alteration of the spatial relationship of the mandible and maxilla resulting changes in the degree of facial projection. Traditional 2-dimensional cephalometry and photographic techniques do not provide data on facial depth. Though stereophotogrammetry can be used as a noninvasive method for evaluating facial depth, the unavailability of ethnicity-specific norms hinder its routine use in clinical practice. The objectives of this study were to (a) generate an analytic scheme suitable for evaluating facial depth using stereophotogrammetry and (b) create normative data for the facial depth measurements for young Hong Kong Chinese adults. Stereophotographic images from 41 male and 45 female ethnic Chinese young adults without facial deformities were analyzed. Facial depth measurements were performed based on standard anthropometric landmarks, with the aid of 3dMDVultus software. All facial depth measurements were found in absolute terms to be significantly ...

A 29-year-old female patient reffered to our department with a chief complaint of functional and facial esthet ical
problems. Subsequent to clinical and radiographic evaluation, patient had skeletal Class II malocclusion, circular
open bite with bilateral crossbite, vertical discrepancy and a convex profile with retrusive upper lip. Due to the
patient had full-arch maxillary fixed prosthesis, it was decided to treat the patient without orthodontic treatment. The
treatment plan was ortognathic surgery subsequently prosthetic rehabilitation and genioplasty. Modified Le Fort I
osteotomy followed by full maxillary prosthetic rehabilitation was administered prior to genioplasty in order to
resolve functional and facial esthetic apperence. In this case report patient had total fixed prosthesis, therefore
orthodontic treatment was not performed. Therefore, surgical approach was planned Le Fort I osteotomy and
advancement genioplasty followed by prosthetic rehabilitation. Surgical t reatment alone with addit ive prosthetic
rehabilitation without any requirement orthodontic treatment would be used in this selected case. The patient
satisfied with both functional and esthetic outcomes on both facial profile and frontal view with in 12 months of
follow-up period.
Keywords: Class II malocclusion; genioplasty;orthognathic surgery

Abstract. The objective of this study was to perform a systematic review and metaanalysis to test the null hypothesis that there is no difference in postoperative
skeletal stability between bicortical screw and monocortical plate fixation after
mandibular advancement surgery with bilateral sagittal split ramus osteotomy
(BSSO). A comprehensive search of major databases (PubMed, EMBASE, and
Cochrane CENTRAL) was conducted to locate all relevant articles published from
inception to October 2015. Studies were selected based on inclusion criteria;
randomized controlled trials, controlled clinical trials, and retrospective studies
comparing bicortical screw vs. monocortical plate fixation after BSSO, reported in
peer-reviewed publications in the English language, were considered eligible.
Changes in linear measurements (horizontal and vertical) were analyzed. Five
relevant studies were identified, involving 203 patients (bicortical screw n = 98,
monocortical plate n = 105). No significant difference was found between
monocortical plate and bicortical screw fixation in horizontal (P = 0.099) or vertical
measurement (P = 0.882). Based on this review, there is overall agreement in the literature that the amount of advancement has a direct relationship with
postoperative changes. The results of this meta-analysis support the hypothesis that
there is no statistically significant difference in skeletal stability between bicortical
screw and monocortical plate fixation of the BSSO following mandibular
advancement surgery

Purpose: Orthognathic surgery may have a positive or negative effect on speech. Perceptual evaluation of presurgical and postsurgical articulation is difficult because speech errors, when they occur, are usually fricative distortions, which may be difficult to document reliably. In this study, acoustic analysis was used to supplement perceptual judgment of presurgical and postsurgical productions of /s/.
Subjects and Methods: The study population consisted of 9 Cantonese speakers undergoing osteotomy for Class III skeletal deformity and 9 age- and gender-matched adults with normal occlusion and speech. The speech sample consisted of 6 words with the initial sibilant sound /s/. Perceptual analysis included narrow phonetic transcription and classification of error types. Acoustic analysis included measurement of first and second spectral peaks, fricative duration, noise bandwidth, and noise-to-vowel decibel ratio.
Results: The results of the perceptual analysis showed a decrease in articulatory errors for the group after surgery, although 5 patients had no perceptual errors before surgery. Acoustic analysis showed significant differences between the experimental and control groups before surgery for 2 variables (spectral peak I and bandwidth). Three months after surgery there were no significant differences between the control group and the experimental group, except for bandwidth. Twelve months after surgery, there were significant differences between the 2 groups in noise bandwidth and spectral peak II.
Conclusions: The results suggest a possible relapse at 1 year after surgery, based on spectral peak values. Osteotomy appears to result in a positive change in articulation for most patients, but speech outcome after osteotomy must be evaluated both 1 year and shortly after surgery.

The term "asymmetry" is used to make reference to dissimilarity between homologous elements, altering the balance between structures. Facial asymmetry is common in the overall population and is often presented subclinically. Nevertheless, on occasion, significant facial asymmetry results not only in functional, but also esthetic issues. Under these conditions, its etiology should be carefully investigated in order to achieve an adequate treatment plan. Facial asymmetry assessment comprises patient's first interview, extra- as well as intraoral clinical examination, and supplementary imaging examination. Subsequent asymmetry treatment depends on patient's age, the etiology of the condition and on the degree of disharmony, and might include from asymmetrical orthodontic mechanics to orthognathic surgery. Thus, the present study aims at addressing important aspects to be considered by the orthodontist reaching an accurate diagnosis and treatment plan of facial asymmet...

Backround Functional and cosmetic defects in the maxillofacial region are caused by various ailments and these defects are addressed according to their need. Simplicity of procedure, intact facial function and esthetic outcome with the least possible donor site morbidity are the minimum requirements of a good reconstruction. Oro-mandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts. Reconstruction of trauma- or mandibular oncologic defects with bony free flaps is considered the gold standard. However the the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection and the timing of surgery. The purpose of this study was to determine the outcome of different osseous reconstruction options using autogenous bone grafts for mandibular reconstructions. Methods This study was carried out on 178 patients with mandibular bone defects. They were reconstructed with autogenous bone grafts from different donor sites. At post operative visits they were evaluated for functional and cosmetic results. Results The success rate found in this study was around 90%. Only 7.6% of the cases showed poor results regarding facial contours and mouth opening. All other patients were satisfied with their cosmesis and mouth opening at the recipient sites was in the normal range during last follow-up visits. Donor sites were primarily closed in all cases and there was no hypertrophic scar. Conclusion Based on this study, autogenous bone grafts are a reliable treatment modality for the reconstruction of mandibular bone defects with predictable aesthetic and functional outcomes. As the free vascularized fibular flap has the least resorption and failure rate, it should be the first choice for most cases of mandiblular reconstruction.

Background: Malocclusion is problem since antiquity. But people’s perception about the problem varies with their
geographical location and cultural background. The problem seems to be more acute in developing countries like
Bangladesh. Objectives: The present study was undertaken to assess the awareness about aesthetic problem of
malocclusion and treatment seeking behavior among the patients attending in orthodontic department of BSMMU.
Methods: The present cross-sectional study was carried out in the Department of Orthodontic, Faculty of Dentistry,
BSMMU, over a period 24 months from January 2008 to December 2009. A total of 110 participants who were suffering
from malocclusion and came for dental treatment were the study population. Results: The mean age of the patients was
21 years and the youngest and the oldest patients were 8 and 32 years old respectively with female to male ratio being
roughly 3:2. Graduate or postgraduate level educated patients were predominant (53.6%). Over 70% of the respondents
viewed malocclusion as an aesthetic problem, 50% as functional problem, 55.5% social problem and 69.1% oral problem.
Two-third (67%) told that malocclusion was a treatable condition. Approximately 43% of the patients identified trauma as
a cause of malocclusion, 40% gingivitis or periodontitis and 35.5% dental caries. About one-third (32.7%) of the respondents
was of the opinion that certain habits should be avoided to prevent malocclusion, 15.5% told timely treatment of
malocclusion, 30% told prevention of early loss of teeth due to caries, 12.7% were in favour of the use of a space
maintainer in places of premature loss of a deciduous tooth. Over 90% of the respondents held the view that symptoms
of malocclusion, its prevention and different treatment options should get the priority in educating the society about
malocclusion. However, 80% of the respondents told that causative factors should discussed. Regarding ways of
behaviour change communication (BCC), TV got the first priority (94%) followed by newspaper (92%), teacher (88%),
school health programme (84.5%), friends (76%), health educators (43.6%) and poster got the least priority (30.9%).
Conclusion: The study concludes that a substantial proportion of the patients of malocclusion are not aware of the
causes and consequence of malocclusion. However, the patients are aware that malocclusion is an aesthetic problem
and can be corrected

Objective: To evaluate the pharyngeal airway and maxillary sinus volume changes after mandibular setback surgery combined with maxillary advancement and/or impaction surgery. Materials and Methods: Seventeen Class III skeletal patients (11 females, 6 males) who required bimaxillary orthognathic surgery were selected. Volumetric measurements were performed using cone beam computed tomography (CBCT) scans preoperatively and 3.9 ± 0.87 months postoperatively. All the CBCT scans were assessed and analyzed using MIMICS 14.0 software. Preoperative and postoperative volumes of pharyngeal airway and maxillary sinuses and the relationship between the amounts of surgical movement of the jaws and the above volumes were statistically evaluated. Results: The pharyngeal airway area presented no significant change except for the lower and total pharyngeal airway volumes in males, in whom a significant decrease was observed (4196.27 ± 2061.11 mm3 and 3375.53 ± 3624.67 mm3, respectively). No signifi...

Objectives: Limited information exists on orthognathic procedures and respective dentofacial deformities in Turkey. This retrospective study assessed the orthognathic surgery procedures in two universities, using the Index of Orthognathic Functional Treatment Need (IOFTN), and compared the IOFTN grades according to gender as well as sagittal and vertical skeletal relationships. Material and Methods: Records of 200 consecutive patients (120 females, 80 males, mean age = 23.4 (SD: 5.4) years) who received orthognathic treatment (2014–2018) were analyzed. Sagittal (ANB angle) and vertical skeletal type (GoGnSN angle), osteotomies, and IOFTN scores were recorded. Results: Class III, II, and I malocclusions formed 69%, 17.5%, and 13.5% of the samples, respectively. Class III skeletal relationships (69%) and high-angle cases (64%) were the most prevalent (p < 0.05). IOFTN scores were unevenly distributed among genders (p < 0.05) and the prevalent scores were 5.3 (40.5%), 4.3 (15.5%)...

In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints. The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained w...

The purpose of the present study was to evaluate the nasopharyngeal airway changes after transnasal adenoidectomy and to determine whether a specific facial morphologic type is associated with hypertrophied nasopharyngeal adenoids. The nasopharyngeal adenoid tissues are present during childhood but usually spontaneously atrophy by 12 to 14 years of age. However, some patients have hypertrophied nasopharyngeal adenoid tissues that can remain after 14 years of age and can cause dysfunction of the eustachian tubes, cause nasal airway obstruction, affect speech, and adversely alter facial growth. In these cases, nasopharyngeal adenoidectomy could be indicated. In patients requiring orthognathic surgery, the adenoidectomy can be performed using a transnasal approach in conjunction with maxillary Le Fort I osteotomy, eliminating the need for a separate surgical procedure.

Abstract
Objectives To evaluate the effect of low-level laser
therapy on healing of extracted tooth socket of healthy
rabbits.
Design The sample of this study was 20 male rabbits of
2–2.5 kg weight with age range of 8–12 months. Right and
left lower first premolar teeth were extracted. The extraction
sockets of lower right first premolar were irradiated
with 0.9 W gallium-aluminum-arsenide (GaAlAs) diode
laser for 5 min, immediately after extraction and then
every 72 h for the next 12 days. The extraction socket of
left side were not exposed to laser and served as a control.
The animals were sacrificed after 7, 14, 30 and 45 days and
the experimental and control sockets were removed from
the harvested mandibles and prepared for haematoxylin
and eosin staining and Masson’s stain. The prepared slides
were examined under light microscope for histological and
histomorphometric examination.
Results The histological examination showed that diode
laser-treated sockets demonstrated early formed new bone
with faster maturation of primary bone to secondary bone
as compared to non-treated control sockets. Histomorphometric
analysis revealed a statistically significant increase
in the density and volume of trabecular bone in lasertreated
sockets than control sockets.
Conclusion Diode laser application to tooth extraction
socket has a positive effect on bone formation.

We conducted a retrospective study and reviewed the temporomandibular joint (TMJ)-related papers published in a leading international journal,
Journal of Oral and Maxillofacial Surgery , between January 2014 and December 2015. The study was conducted to ascertain and compare the trends
of articles being published in the years 2014 and 2015. A total of 28 articles were reviewed, of which most of the full-length articles were on clinical
management and outcomes and the role of radiology. The bulk of the studies were prospective, and less interest was shown in experimental research. A
thorough review and analysis thus gives the impression that there is a great need for well-designed clinical studies on TMJ.

Orthognathic surgery can induce changes in airway volume. The aim of this study was to determine whether there is a correlation of surgical movement of the maxilla or mandible to airway volume changes. This was a prospective cohort study and the sample was composed of patients undergoing single-jaw orthognathic procedures from 2004 through 2007. Cone-beam computed tomograms were obtained before surgery (T0), immediately after surgery (T1), and at least 6 months after surgery (T2). The airway was segmented from 3-dimensional images and identified as the whole airway, consisting of the naso-, oro-, and hypopharynx. The volumetric percentage of change of the airway between time points was compared and correlated to the surgical movements using paired t test and cubic regression analysis. The level of statistical significance was set at a P value less than or equal to .05. The sample was composed of 33 patients. Sixteen patients underwent maxillary advancement with mean advancement of 5...

Background The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. Methods Our search was performed in PubMed, EMBASE, Cochrane Library and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using intra-class correlation coefficient, and linear and angular differences in three planes. Results The comparison of the accuracy analyses of the examined method has shown an average translation (

Repositioning of the maxilla in orthognathic surgery is carried out for functional and aesthetic purposes. Pre-surgical planning tools can predict 3D facial appearance by computing the response of the soft tissue to the changes to the underlying skeleton. The clinical use of commercial prediction software remains controversial, likely due to the deterministic nature of these computational predictions. A novel probabilistic finite element model (FEM) for the prediction of postoperative facial soft tissues is proposed in this paper. A probabilistic FEM was developed and validated on a cohort of eight patients who underwent maxillary repositioning and had pre- and postoperative cone beam computed tomography (CBCT) scans taken. Firstly, a variables correlation assessed various modelling parameters. Secondly, a design of experiments (DOE) provided a range of potential outcomes based on uniformly distributed input parameters, followed by an optimisation. Lastly, the second DOE iteration p...

BACKGROUND AND AIM: The factors affecting the attractiveness of the soft tissue profile are assessed in only very few nonmatched and controversial studies. We aimed to evaluate these factors in a matched comprehensive study.

METHODS: Profile photographs of 100 students with good occlusion were sorted according to facial beauty by 20 judges. After excluding 40 unmatched subjects or those with marginal scores, 12 soft tissue variables were compared among profiles of 30 attractive and 30 unattractive matched participants (t test, α = 0.05).

RESULTS AND CONCLUSION: As the most important factor, excessive mandibular retrusion made both men and women unattractive. Both attractive men and women tended to have less prominent noses with higher nose tips, protruded upper lips compared with the position of lower lips, and deeper lower faces. Closeness of lips to the middle of vertical chin-nose distance enhanced female beauty only. Straight profiles and more protruded maxillae merely made men more attractive.

Introduction: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. Material and Methods: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin ImagingTM software version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower th...

Orthognathic surgery is one of the most important treatment options available to an orthodontist, especially in cases of significant skeletal malocclusions. In order to accurately measure any changes that may have occurred following orthognathic surgery, data regarding shape changes occurring in the temporomandibular joint is necessary. CBCT imaging can provide more complete three-dimensional information related to these changes than has been possible in the past. The use of three-dimensional CBCT data has allowed for a more complete analysis of changes that have taken place in the TMJ with orthognathic surgery, with changes primarily taking place bilaterally in posterior, superior, and lateral aspects of the condylar heads and posterior regions of the fossae.

This study tests computer imaging software (SurgiCase-CMF(®), Materialise) that enables surgeons to perform virtual orthognathic surgical planning using a three dimensional (3D) utility that previews the final shape of hard and soft tissues. It includes a soft tissue simulation module that has created images of soft tissues altered through bimaxillary orthognathic surgery to correct facial deformities. Cephalometric radiographs and CT scans were taken of each patient before and after surgery. The surgical planning system consists of four stages: CT data reconstruction; 3D model generation of facial hard and soft tissue; different virtual surgical planning and simulation modes; and various preoperative previews of the soft tissues. Surgical planning and simulation is based on a 3D CT reconstructed bone model and soft tissue image generation is based on physical algorithms. The software rapidly follows clinical options to generate a series of simulations and soft tissue models; to avo...

Three-dimensional virtual treatment planning has greatly enhanced the efficiency and accuracy of dentofacial deformity correction through orthognathic surgery [1]. Moreover, the advent of rigid internal fixation has allowed a change in this classical sequence. Performing mandibular surgery first presents several advantages and surgeons must consider some indications in order to achieve better results, and the ability of the surgeon to reproduce the treatment plan in the operating room is essential [2]. Most of orthognathic surgery treatment plan has been performed by traditional sequence, but the surgery itself was performed using an inverted sequence. However, repositioning the lower jaw first during three-dimensional virtual planning, as well as in actual surgery, can be really advantageous. The purpose of this paper is to suggest a protocol for double-jaw orthognathic surgery repositioning the mandible first in both three-dimensional virtual planning and surgery itself. Tridimensional virtual planning protocol