Esthetic corrections in cases of orthognathic surgery

When orthognathic surgery is performed to produce functional improvement of the maxillomandibular complex, additional esthetic corrections to harmonize facial proportions are often necessary as well as desired by the patient. Simultaneous profile corrections occur with orthognathic surgery, but rhinoplasty requires a second intubation after the correction of the maxillomandibular complex. In the case of an asymmetric facial deformity, a two-stage procedure is recommended because positioning of the soft tissues is more easily planned after the jaws have healed and are functioning in their new positions. Several examples of soft tissue changes and their respective orthognathic procedures are described.     

Unilateral otitis media with effusion caused by retained surgical gauze as an unintended iatrogenic complication of orthognathic surgery: case report

Inadvertent retention of surgical gauze during an operation can have disastrous consequences for both the patient and the surgeon. Several cases have been reported, particularly after abdominal surgery. However, it has never to our knowledge been reported as a leading cause of dysfunction of the Eustachian tube after orthognathic surgery. We recently encountered a patient in whom it presented with unilateral otitis media with an effusion after orthognathic surgery. All surgeons involved with orthognathic surgery should be aware that remnants of surgical gauze after orthognathic surgery can compromise the Eustachian tube and cause otitis media with an effusion.     

Fractal analysis of mandibular bony healing after orthognathic surgery

OBJECTIVES: We evaluated the radiographic changes to the operational sites after orthognathic surgery by using fractal analysis. STUDY DESIGN: Panoramic radiographs from 35 patients who underwent orthognathic surgery on the mandible without any complications during the osseous healing process were selected. The radiographs taken before the operation (stage 0) and 1 or 2 days (stage 1), 1 month (stage 2), 6 months (stage 3), and 12 months (stage 4) after the operation were digitized at 600 dpi with 256 gray levels. The fractal dimension was calculated by means of a tile-counting method in the region of interest centered on the operational site and was statistically analyzed according to its stages. RESULTS: The fractal dimension was decreased immediately after the operation and increased gradually according to the time lapse (P <.05). The fractal dimension in the region of interest 12 months postoperatively was similar to that preoperatively. CONCLUSION: This result suggests that fractal dimension can be used to evaluate the bony healing process after orthognathic surgery.     

正颌外科三维立体可视化模拟手术研究

目的：建立基于CT图像数据的计算机辅助三维立体手术模拟系统，为了术前进行精确设计手术方案及达到术后良好效果提供真实可靠依据。方法：应用医学可视化技术和Visual C^**编程语言开发出立体结构三维重建和手术模拟软件，建立以CT数据为信息源的计算机正颌外科立体可视化手术仿真模拟系统，可模拟各种正颌外科手术移动骨质过程，并且以动态动画形式演示，可从任意角度进行观察。结果：该系统建立了颅颌面畸形立体结构模型，以动态形式成功演示了正颌外科截骨移动手术仿真模拟，手术过程真实逼真，立体可视化效果好，应用普通播放软件即可在计算机屏幕上播放模拟正颌外科手术过程，并可预测手术后上下颌咬合状态及手术效果。结论：正颌外科三维立体可视化模拟手术系统的建立，为正颌外科截骨矫治牙颌面畸形术前手术方案制定提供实用有效的技术手段和全心的科学方法，改变仅凭主观经验诊断畸形和设计手术方案的传统模式，可在计算机屏幕前制定手术方案进行医患交流，共同协商，提高了正颌外科手术安全性、精确性和矫治效果。     

颌骨骨折错位愈合的正颌外科治疗

目的 :应用正颌外科原理及方法 ,治疗 8例颌骨骨折错位愈合的病人。方法 :按正颌外科常规 ,术前摄头颅定位正侧位片 ,取模 ;头影测量及模型外科等 ;采用正颌外科常用术式进行手术 ,微、小型钛板内固定 ;术后颌间固定 2周。结果 :伤口一期愈合 ,颌牙合关系及外观基本恢复伤前状况。结论 :应用正颌外科原理及方法治疗颌骨骨折错位愈合 ,能基本恢复病人伤前的咀嚼功能及外观。     

Aesthetic surgery to augment orthognathic surgery

The purpose of this article is to discuss some of the more commonly performed aesthetic surgical procedures to augment the final outcome of orthognathic surgery. These procedures are divided into two categories: those that can safely and predictably be performed simultaneously with orthognathic surgery and those that ideally should be performed independently of orthognathic surgery. This latter category also includes camouflage surgery, which includes aesthetic surgical procedures that are performed to camouflage or mask underlying dentofacial deformities in patients who, for various reasons, are not candidates for traditional orthognathic surgery or prefer a "smaller" operation. Camouflage surgery may be an attractive alternative for this group of patients because it is usually a much smaller operation and has a shorter recovery period.     

矫治不良颌间关系与同期种植术

目的 探讨正颌外科方法矫正缺牙区不良咬合关系同时行种植术中的可行性,评估其效果及临床价值。方法 对９例患者行正颌外科手术。其中 上颌Ｌｅ Ｆｏｒｔ Ｉ型截骨术、下颌双侧升支矢状劈开截骨术（ＳＳＲＯ）３例,单纯下颌ＳＳＲＯ１例,下颌前部根上截骨术４例,双侧上颌后部截骨术１例,共植入种植体２５颗。结果 ９例术后均取得了正常的咬合关系,未见感染及术后并发症。术后８个月患者接受种植体上部结构修复,平均追踪     

Long-term skeletal stability in the treatment of mandibular prognathism with a physiological positioning strategy

Our aim was to evaluate the long-term skeletal stability of the mandible in 21 patients after orthognathic surgery with physiological positioning. The measurement points SNB, B point (X, Y), Pog (X, Y), and the angle of the ramus were measured on cephalometric photographs to assess skeletal stability preoperatively, immediately after operation, and one and two years postoperatively. In addition, we evaluated the clinical symptoms of disorders of the temporomandibular joint (TMJ). The analysis of the cephalometric photographs showed that SNB, B point X, and Pog X showed no significant differences among the postoperative time points. On the other hand, B point Y and Pog Y showed no significant differences throughout the study period. We compared the angle of the ramus before operation and two years postoperatively, and no significant difference was found. In addition, no cases showed any pathological symptoms of disorders of the TMJ two years postoperatively. The long-term stability after orthognathic surgery with physiological positioning was confirmed, and it seems to be a reliable orthognathic treatment in patients with mandibular prognathism.     

A retrospective evaluation of rigid fixation in orthognathic surgery using a biodegradable self-reinforced (70L:30DL) polylactide

OBJECTIVE: This study was designed to evaluate clinical and radiological evidence of osteotomy site healing in orthognathic surgery after rigid fixation using a biodegradable plating system. STUDY DESIGN: A follow up of 30 patients who underwent orthognathic surgery using a biodegradable self-reinforced (70L:30DL) polylactide plating system was presented. The follow-up schedule for all patients consisted of regular appointments at 1-180 days after surgery. Clinical evaluation involved notation of any abnormal swelling, infection, discoloration, or discharge at the osteotomy sites. Stability was evaluated by manual palpation. For radiographic evaluation, panoramic radiographs were taken immediately after surgery, and again at 7-180 days. The radiographs were analyzed for any visual changes in osteotomy fragments, resorptive changes in osteotomy fragments, callus formation, and union of the osteotomy segments. RESULTS: No clinical complications and no radiological changes in the osteotomy sites were observed. Regarding the clinical usefulness of the biodegradable fixation system, fixation at the time of operation was considered as excellent in all 30 cases. CONCLUSIONS: The conclusions of this study were that self-reinforced (70L:30DL) polylactide was considered to be comparable to other forms of rigid internal fixation for orthognathic surgery.     

An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic

The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.     

Risk of surgical glove perforation in oral and maxillofacial surgery

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.     

Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用与评价

目的:观察分析Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用效果.方法:回顾2004年3月至2006年12月武汉大学口腔医学院口腔颌面外科收治的唇腭裂患者的临床资料,并进行总结与分析,所有患者均进行了以Le Fort Ⅰ型截骨术为主的正颌外科治疗.结果:共收集相关病例16例,其中男9例,女7例,平均年龄22.4岁.术前∠SNA平均73.2°,术后LSNA平均79.5°;上颌前移距离平均8.13mm.平均随访时间7.3个月.所有患者术后面容改善明显,经正畸治疗后咬合关系满意.结论:以Le Fort Ⅰ型截骨术为主的正颌外科治疗,可以显著改善唇腭裂患者的颌骨与面容畸形.     

Bilateral benign paroxysmal positional vertigo: an unusual complication of orthognathic surgery

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo of labyrinthine origin and usually idiopathic. However, 15–20% of all cases occur after trauma to the head, and it has rarely been reported after maxillofacial surgery, so to the best of our knowledge this is the first report of its bilateral occurrence after orthognathic surgery. It resolves slowly, but symptoms are incapacitating. It can be diagnosed from the history and physical examination, including the Dix–Hallpike test. Maxillofacial surgeons should be aware of it in patients who complain of dizziness after orthognathic surgery, and should know how to manage it properly.     

The psychological and behavioral considerations of orthognathic surgery on identical (monozygotic) twins

The psychologic and behavioral changes that may occur with the impact of orthognathic surgery on the physical appearance of an identical twin set have been addressed. This unique situation has not been discussed in the literature with respect to reconstructive or cosmetic facial surgery. A report on elective orthognathic surgery performed on identical twins and the subsequent impact on the twin relationship due to alterations of "self-image phenomenon" is given. Such an impact was a consideration in this case. Further collective study in this area is needed but is difficult to obtain because of the rarity of occurrence of this type of case.     

Orthognathic surgical planning on three-dimensional stereolithographic biomodel

The aim of this report was to present the orthognathic surgical planning of a patient with maxillary retrusion, mandibular prognathism, and midline shift on a three-dimensional stereolithographic biomodel. A patient who complained about facial deformity and difficulty in chewing was referred to our department. After a short-term presurgical orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. Triangular axial gaps occurred anteriorly and posteriorly between the proximal and distal segments of the osteotomized mandible. These gaps were filled with bone grafts in accordance with templates that were constructed on a three-dimensional stereolithographic biomodel. Rotational movement of the distal mandibular segment around the y axis caused axial triangular gapping between the proximal and distal mandibular segments. In the presented case, orthognathic surgical planning was performed on the three-dimensional solid models, and templates were reconstructed according to these gaps. These templates were used to determine the size of the bone grafts during the surgical approach. The patient was diagnosed with lateral cephalometric and posteroanterior cephalometric analysis in postretention for 2 years, and it was determined that long-term results were perfect and skeletal relapse did not occur after 2.5 years of surgery. Movement at the site of the osteotomy is usually the main cause of relapse after orthognathic surgery. In the presented case, a three-dimensional stereolithographic biomodel was used to plan the orthognathic surgery and to reconstruct the templates to determine the size and shape of the bone grafts. Using bone grafts established close contact between proximal and distal osteotomized bone segments, enhanced bone healing, and diminished relapse risk.     

Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism

The aim of this study was to determine changes in overnight respiratory function and craniofacial and pharyngeal airway morphology following orthognathic surgery. The subjects were 40 patients in whom mandibular prognathism was corrected by orthognathic surgery: a one-jaw operation in 22 patients and a two-jaw operation in 18 patients. Morphological changes were studied using cone beam computed tomography immediately before surgery and at more than 6 months after surgery, and the apnoea–hypopnoea index (AHI) was measured with a portable polysomnography system. Pharyngeal airway volume was decreased significantly after surgery, especially in the one-jaw operation group. AHI was not changed significantly after surgery in either group, although AHI in one patient in the one-jaw operation group was increased to 19 events/h. There was no significant change in pharyngeal airway morphology in that patient, but he was obesity class 1 and was 54 years old. In conclusion, some patients who are obese, have a large amount of mandibular setback, and/or are of relatively advanced age may develop sleep-disordered breathing after mandibular setback; a two-jaw operation should therefore be considered in skeletal class III patients who have such risks because it decreases the amount of pharyngeal airway space reduction caused by mandibular setback surgery.     

Changes in bite force and occlusal contact area after orthognathic surgery for correction of mandibular prognathism

OBJECTIVE: This study examined the long-term changes of bite force and occlusal contact area in patients with prognathous after orthognathic surgery with a newly developed pressure-sensitive sheet (Dental-Prescale; Fuji Photo Film Co). STUDY DESIGN: Fifty-seven patients with prognathous were examined. Bite force and occlusal contact area were measured just before operation and at 2 weeks, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after operation. Forty control subjects with normal occlusion were also measured. RESULTS: The bite force and occlusal contact area of the patients were significantly greater than the preoperative level at 1 year, 2 years, and 3 years after operation. However, they were still significantly lower than the control subject level even at 3 years after operation. CONCLUSIONS: This study suggests that orthognathic surgery improves the bite force and occlusal contact area of patients with prognathous. However, at 3 years from the time of operation, patients had not reached control subject levels.     

正颌外科手术前、后患者人格特征的变化

目的:测量和评估正颌外科术前和术后患者的人格特征及其变化。方法:选取中山大学附属口腔医院正颌外科中心2008年6月—2009年3月实施正颌手术的患者36例,以2006年华东师范大学选取325名受试者(大学生161名,外企员工164名)所制定的常量表为对照组,采用美国卡特尔教授编制的卡特尔16种个性因素问卷(16PF),测量患者手术前、后的人格特征并分析其变化,应用SPSS10.0软件包对数据进行t检验。结果:正颌外科手术前,患者组的16PF-A因素(乐群性)、16PF-F因素(活跃性)和16PF-L因素(警惕性)与对照组相比具有显著性(P<0.05);术后3个月复诊患者31例,患者16PF-A因素(乐群性)和16PF-L因素(警惕性)在术前、术后存在显著差异(P<0.05)。结论:正颌外科手术患者有缄默、孤独、冷漠,喜欢待在自己的小圈子,不爱与人交流的倾向;同时有轻松、兴奋、随遇而安,对事件抱有无所谓的态度;存在敏感多疑,不信任别人,与人相处常常斤斤计较,不顾及别人利益的人格特征倾向;术后3个月,患者开始变得外向、热情、乐群,信赖随和,容易与人相处,但患者轻松、兴奋、随遇而安,对事件抱有无所谓的态度并无明显改变。     

硝酸甘油复合艾司洛尔控制性降压在正颌手术中的应用

目的　观察硝酸甘油复合艾司洛尔控制性降压在正颌手术中的降压效果。 方法 选择ASA I或II级,择期行正颌手术患者60例,采用随机数字表法均分为硝酸甘油组（N组）和硝酸甘油复合艾司洛尔组（NE组）。手术开始离断上颌骨前2分钟开始降压,两组硝酸甘油初始剂量4 μg?kg-1?min-1,NE组同时泵注艾司洛尔150 μg?kg-1?min-1,降压维持到上颌骨离断完成时停止。观察并记录各组患者降压前即刻(T0)、达到目标血压时(T1)、达到目标血压后5min (T2)、停止降压后5min (T3)、停止降压后10 min (T4)的MAP、HR和CVP。于术前、术毕检测Hb、Hct含量,计算出血量;记录硝酸甘油用量和截骨手术时间。结果 与N组相比,NE组HR在T1,T2,T3时明显降低,MAP在T1、T3、T4时明显降低,截骨手术时间缩短,硝酸甘油用量减少(P＜0.05),两组患者出血量, CVP差异无统计学意义。结论 与单纯使用硝酸甘油相比,硝酸甘油复合艾司洛尔能够减少硝酸甘油用量,缩短截骨手术时间,抑制硝酸甘油引起的反射性心率增快,从而更能满足正颌手术的需要。     

颌面部不对称畸形的正颌外科治疗--附44例报告

目的：探讨治疗颌面部不对称畸形的各种正颌手术方法组合。为治疗这种畸形提供临床参考。方法：回顾性随访第四军医大学口腔医学院颌面外科1987-1999年用正颌外科治疗的44例颌面部不对称性畸形患者，总结其临床疗效和经验。结果：除一例患者偏颌畸形术1年复发外，其余患者均恢复了对称的面部形态，咀嚼功能，咬合关系和咬合平面，治疗效果满意，结论：应根据患者不对称畸形的不同原因和部位制定相应的正颌治疗方案，选择不同的术式组合，同时结合关节手术可获得满意的疗效。