Psychological aspects of dentofacial esthetics and orthognathic surgery

The literature and the results of the survey clearly confirm that physical attractiveness plays a major role in the social life and interaction among individuals. Cosmetic improvement is a powerful motivating factor leading people to seek treatment. Those who believe that the rewards of facial improvement will enable them to lead more satisfying and comfortable lives should be encouraged to proceed with the treatment. However, it is absolutely essential that those contemplating treatment be counseled before-hand and fully informed on the prognosis, risks and hazards, advantages and disadvantages of such procedures before embarking on treatment.     

Preoperative nutritional supplementation for the orthognathic surgery patient

Orthognathic surgery patients were studied to determine the nutritional adequacy of a high-calorie liquid supplement. The supplements were given for one month before surgery in an attempt to achieve a 5% weight gain and/or for six weeks after surgery to approximate 50% of the estimated caloric requirements of the patients. It was concluded that preoperative supplementation to achieve weight gain before surgery is of no apparent value. However, balanced nutrient intake can be achieved for patients when supplementation is given postoperatively at a level of 50% of estimated caloric requirements, and can result in improved nitrogen retention and protein sparing.     

Postoperative nutritional supplementation for the orthognathic surgery patient

Twenty-four orthognathic surgery patients were studied to determine the impact of a high-calorie liquid supplement on preventing or minimizing catabolism commonly associated with surgery. The experimental group of 12 subjects, chosen at random, consumed blenderized foods ad libitum and a high-calorie dietary supplement providing a minimum of 50% of energy requirements. The remaining 12 subjects consumed only blenderized foods and served as the control group. The nutritional status of all patients was assessed one day before surgery and on Day 7 of the first, third, and sixth postoperative week. In general, nutrient intake in the experimental group remained similar to that before surgery, whereas intake in the control group decreased significantly, particularly at the one-week postoperative evaluation. It was concluded that the addition of a high-calorie liquid supplement to the dietary regimen of orthognathic surgery patients helped maintain nutrient intake at a level comparable to that before surgery. This resulted in better maintenance of body weight and somatic protein compartments compared with the control group.     

The role of total joint replacement surgery in the orthognathic patient

Alloplastic reconstruction of the temporomandibular joint, commonly referred to as total joint replacement, is used to treat end stage joint disease in a cohort of patients who present with a range of condylar pathology. In considering its role in the management of the orthognathic patient, it is helpful to categorize patients into those with primary pathology of the mandibular condyle or those with primary dentofacial deformity. The success of total joint replacement is predicated by the predictably stable results that are achieved when used in carefully selected clinical scenarios. In this article, we will discuss the role of total joint replacement surgery in the orthognathic patient and highlight its clinical impact by inclusion of a case study.     

Management of a large lingual thyroid in the orthognathic surgery patient

The embryogenesis, signs and symptoms, diagnosis, and clinical management of the lingual thyroid entity are discussed. A patient with a large lingual thyroid, who also required a mandibular set-back osteotomy, is presented. The preoperative, intraoperative, and postoperative considerations and management of this patient as they relate to the lingual mass and its possible effects on the airway are discussed.     

Quality assessment of patient information on orthognathic surgery on the internet

ObjectiveThe aim of this study was to assess the quality of online information for patients on orthognathic surgery.Materials and methodsA selection of search terms specific for orthognathic surgery was chosen and 150 websites were identified using the Internet search engines Google, Yahoo and Bing. Irrelevant websites were excluded. The remaining websites were assessed with a modified Ensuring Quality Information for Patients (EQIP) tool. EQIP evaluates the quality of medical patient information by measuring the three key aspects of content, structure, and identification data.Results48 relevant websites were identified. EQIP values ranged between 2 and 28 (median 13.65). While 37 of the 48 websites described details of the surgical procedures, only 13 mentioned possible risks and complications of the surgery. No differences were found between the websites of private practices, dentists and public hospitals, universities, or others (p = 0.66). Websites found by Google had a significantly lower EQIP score compared with Yahoo and Bing (11.12 vs. 16.60 for Yahoo and 16.23 for Bing; p = 0.012). The better the rank of the website, the higher the EQIP score (r = −0.411, p = 0.004).ConclusionsThe results of this study reflected a large variation of quality of information on orthognathic surgery on the Internet. Therefore, surgeons must be aware that they might be confronted with unrealistic expectations of patients, who may underestimate the potential risks and drawbacks of orthognathic surgery.     

天然型无机骨颌面植入体在正颌外科的应用

目的 验证天然型无机骨颌面植入体在正颌外科中应用的有效性。方法 ３０例患有各种颌面畸形的正颌形的正颌外科患者植入了天然型无机骨,植入方式全部为表面贴覆。结果 此种骨代用品具有良好的组织相容性和稳定性,植入手术的并发症少见,软组织改变明显。结论 病例选择合适,天然型无机骨在正颌外科患者中将起到改善面部外科,节省自体骨的目的。     

Treatment of a patient with metal hypersensitivity after orthognathic surgery

In this case report, orthodontic materials may have induced metal allergic reactions in the form of lip swelling and redness after orthognathic surgery. Two months after surgery, the patient suffered continuous lip swelling and redness. She visited a dermatological hospital and was diagnosed with herpes. However, since her symptoms did not improve after 1-month of drug therapy, a metal allergy was subsequently suggested. Patch tests conducted in the dental hospital revealed reactions to chromium, which is not used in prosthetic appliances. For confirmation, the metal composition of all prosthetic appliances was examined using a fluorescent x-ray analyzer, but no chromium was detected (copper, gold, palladium, and silver were detected). However, the orthodontic brackets, wires, and bands do contain chromium and, considering that they may have induced the metal allergic reactions, they were replaced with materials made of polymer with no metals. As a result, the lip swelling and redness improved. For retention, the anterior part of the retainer was bonded on the lingual side of the anterior lower and upper jaws. During retention, no further symptoms of hypersensitivity were observed, suggesting that the nonmetal polymer is useful for treatment of metal allergic patients.     

Reprint of the role of total joint replacement surgery in the orthognathic patient

Alloplastic reconstruction of the temporomandibular joint, commonly referred to as total joint replacement, is used to treat end stage joint disease in a cohort of patients who present with a range of condylar pathology. In considering its role in the management of the orthognathic patient, it is helpful to categorize patients into those with primary pathology of the mandibular condyle or those with primary dentofacial deformity. The success of total joint replacement is predicated by the predictably stable results that are achieved when used in carefully selected clinical scenarios. In this article, we will discuss the role of total joint replacement surgery in the orthognathic patient and highlight its clinical impact by inclusion of a case study.     

Effects of orthognathic surgery on nasal form and function in the cleft patient.

Management of common problems of nasal airway obstruction in cleft and noncleft patients by the subnasal approach through the maxillary Le Fort I osteotomy are discussed. The effects of maxillary surgical repositioning on the esthetics of the nose and upper lip are presented, as well as the sequencing and timing of orthognathic surgery and nasal reconstruction in the cleft patient. Case presentations illustrate the results of this treatment approach.     

Psychological aspects of orthognathic surgery: how people respond to facial change

This study was undertaken to explore the motivations and problems shared by adult orthognathic surgical patients over the age of 25. Objective findings included demographic information and reasons for seeking surgery. The majority of 65 respondents cited functional problems as their primary reason for seeking treatment. Eighty-nine percent were pleased with esthetic changes, and 83% responded that the functional problem had been corrected. For most, the greatest discomfort related to the surgery was the postoperative intensive care unit. Two of the most common side effects of the surgery were the loss of sensation in the lips and chin area and a short period of depression. Women had depression more often than men but were more enthusiastic about the final results of the procedure. Two major areas of interest to surgeons emerged from the research. First, although women have functional problems, the majority seem to have a desire for cosmetic improvement. Having a functional problem seemed to provide the psychological permission necessary to spend the time and money for a cosmetic change. The second point focused on the need for good communication between surgeon and patient. The patients who were more positive toward the procedure and more satisfied with the results were those who were better informed and who thought they had a good system of communication with the orthodontist, surgeon, and their respective staffs.     

Perception of improvement after orthognathic surgery: the important variables affecting patient satisfaction

Purpose

We evaluated which factors affect patient satisfaction and if patient expectations were fulfilled after orthognathic surgery.

Methods

Questionnaires consisting of 14 questions were given 1 year after bimaxillary osteotomy for class-III correction to subjects. Six questions were answered using an 11-point rating scale based on a visual analog scale (VAS; 0?=?poor; 10?=?excellent). Also included were seven closed-form questions with yes/no answers, as well as one open question for ‘further remarks’. Sagittal and vertical cephalometric parameters were determined on postoperative cephalograms.

Results

Seventy-seven patients (37 females, 40 males; mean age, 23.4?±?4.9 (SD) years) responded. The intention to undergo surgery only for aesthetic improvement was noted in 11.9% of patients; only improvement of chewing function in 15.5%; both in 71.4%; and none/don't know in 2.6%. Postoperative satisfaction was rated (in means) with 8.13?±?1.97 on VAS and correlated significantly with the opinions of friends and relatives. Facial aesthetics was rated 5.6?±?1.2 before surgery and 8.1?±?1.5 after surgery (p?=?0.04). Preoperative chewing function was rated 5.65?±?1.8 and 8.03?±?1.51 after surgery (p?=?0.014). TMJ disorders or hypoesthesia had no negative impacts. Cephalometric analyses revealed a significantly lower SNB (75.3°?±?2.7°; p?=?0.033) in patients rating lower than grade 7 for overall satisfaction. For SNA and ArGoMe, no significant differences were observed.

Conclusion

The most distinctive factors for patient satisfaction after orthognathic surgery were chewing function and facial aesthetics with respect to the lower face. Function, aesthetics, and even psychological aspects should be considered equally when planning surgery.     

Rathke's cleft cyst: incidental finding in an orthognathic surgery patient

A case of this rare parasellar cyst is reported in a patient presenting for orthognathic surgery. The pathogenesis, clinical, histologic and radiologic features of this cyst are reviewed. This case underscores the necessity of careful evaluation of cephalometric radiographs.     

Complications of orthognathic surgery

Complications in orthognathic surgery may stem from occurrences at anyone of many time points during the course of the patient's treatment: preoperative judgment and planning, perioperative orthodontic care, or intraoperatively. This article specifically addresses those complications that arise as a result of intraoperative technique. Such complications may broadly be characterized as airway, vascular, neurologic, infectious, skeletal, or aesthetic in nature. For each type, specific complications, their prevention, and their treatment are discussed.