[Gnathological set-up in orthognathic surgery. 1. Orthognathic surgery].
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Humans↗
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Are hearing and middle ear statuses at risk in Chinese patients undergoing orthognathic surgery?
Orthognathic surgery, which is performed to correct dentofacial abnormalities, has been associated with postoperative reduction in hearing sensitivity and middle ear dysfunction. In this study, the pre- and postoperative hearing status and middle ear function of 37 Chinese subjects who underwent orthognathic surgery, as well as subjective reports of aural symptoms, particularly hearing loss, tinnitus, fullness and otalgia, were investigated. There was a significant increase in the number of subjects with measured loss, perceived loss and aural fullness from pre-surgery to 1 week post surgery. However, the percentage of increase was small compared with previous findings. This difference in findings was attributed to the type of surgical techniques used, and to the fact that the Chinese population appears to be less susceptible to middle ear effusion. Subjective complaints of aural symptoms may not be accompanied by measured loss.
Adolescent↗
[Orthognathic surgery, master-piece of maxillo-facial surgery].
Orthognathic surgery is this field of the maxillofacial surgery which aims to reposition the jaws or some segments of these jaws when masticatory dysfunctions are evident. This tridimensional repositioning in the craniofacial skeleton allows to restore the masticatory function by means of osteotomies, which must be followed either by preoperative simulated bony displacements or by callus bone distraction. Not only are the functional benefits evident on the dental, articular and neuromuscular levels, but also a facial esthetic harmony can almost be obtained.
Humans↗
Biotechnical and other factors affecting orthognathic surgery.
Orthognathic surgery is a rapidly growing biotechnologic interaction involving alterations of facial form and dental occlusion. This article describes some of the important and complex psychological, sociological, ethical, and public policy issues involved. Advances in the latter issues are necessary for advancement of the field.
Adolescent↗
Comparison of methods to assess neurosensory alterations following orthognathic surgery.
Orthognathic surgery may damage branches of the trigeminal nerve, resulting in postoperative neurosensory disturbances. Alterations may be due to surgical edema, stretching, or direct trauma to the nerve. Lack of a standard and objective method of assessment hinders efforts to study and/or reduce the incidence of neurosensory disturbances. This study compared three methods of assessing neurosensory disturbances in patients who underwent bilateral mandibular ramus sagittal split osteotomies. Forty patients (26 female, 14 male) ranging in age from 23 to 47 years participated in the study. All of the patients had bilateral mandibular ramus sagittal split osteotomies and were stabilized with rigid skeletal fixation. Neurosensory testing was performed prior to surgery, and at 2 weeks, 1 month, 3 months, 6 months, and 1 year following surgery. Methods of assessment included two-point discrimination, threshold to electrical stimulation, and somatosensory evoked potentials. Threshold to electrical stimulation and two-point discrimination were obtained by the two-alternate forced choice technique.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
A splint designed for easy fixation and release during orthognathic surgery.
Orthognathic correction of jaw deformity may require a period of inter-maxillary fixation (IMF) at operation or during the post-operative period. A splint has been designed which may be used for both fixation and localisation of the jaws and which employs a quick release mechanism designed for use during surgery. It may be used also by the patient when intermittent fixation is required post-operatively and by non-medical staff in the event of an emergency such as airway obstruction.
Dental Alloys↗
Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery.
False aneurysms and arteriovenous fistulas are rare complications of orthognathic surgery. The vessel most commonly involved with false aneurysms following mandibular surgery is the internal maxillary artery, and this vessel, especially the sphenopalatine branch, may also be involved following maxillary surgery. An unusual factor in the presentation of false aneurysms following Le Fort I osteotomies is an initial episode of epistaxis occurring greater than 2 weeks postoperatively. Arteriovenous fistulas following orthognathic surgery are more apt to involve large vessels, especially the internal carotid artery. Embolization procedures are the treatment of choice for false aneurysms and arteriovenous fistulas in the maxillofacial region following orthognathic surgery.
Adolescent↗
Actinomycosis as a rare complication of orthognathic surgery.
Modern orthognathic surgery is said to be clean contaminated due to the intraoral means of access. Complications after orthognathic surgery, a common operation, occur about 10% of the time. Actinomycosis, a rare specific infection, plays a negligible role. Diagnostically, it should be differentiated from other infections that occur a long time after the operation. Three cases of actinomycosis that occurred after orthognathic surgery were observed, and therapeutic measurements are described case by case.
Abscess↗
Complications of orthognathic surgery.
Although orthognathic surgery has now become a routine part of oral and maxillofacial surgery practice, concern and apprehension about major jaw surgery continues to plague the minds of many orthodontists faced with the prospect of referring their patients for surgery. Like all surgery, complications also occur with orthognathic procedures, most of which can be prevented by thorough planning and careful surgery. In this article a brief overview of the potential complications associated with orthognathic surgery is presented for the benefit of orthodontists involved in the management of patients undergoing combined orthodontic-surgical treatment.
Humans↗
Current concepts in aesthetic orthognathic surgery.
While orthognathic surgery provides a significant improvement in masticatory, dentofacial, and airway function, proper and considered preoperative planning can significantly enhance facial harmony and balance as well. Also, orthognathic procedures to correct underlying skeletal discrepancies in concert with, or prior to, other cosmetic procedures can greatly enhance the patient's final result. This paper reviews the use of the occlusal plane angle as a guide for improved aesthetic results with bimaxillary orthognathic surgery. It also provides several examples of facial cosmetic procedures performed as an adjunct to dentofacial surgery. A rationale of timing of these procedures is offered.
Adult↗
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.
Adolescent↗
Presurgical satisfaction with facial appearance in orthognathic surgery patients.
Orthognathic surgery and orthodontic therapy are most often performed to improve the patient's appearance. However, not all patients are satisfied with the result though the procedure may be considered successful by the orthodontist and the maxillofacial surgeon. It has been suggested that the patient's satisfaction with his or her facial appearance before the surgery can predict later satisfaction with orthognathic procedures. The present study examined the role of several potential predictor variables in satisfaction with facial appearance before orthognathic treatment. The variables, identified in previous research, included severity of facial disharmony, self-concept, psychological distress, gender, age, and socioeconomic status. Questionnaires were gathered from 54 patients in 10 orthodontic practices in Connecticut and New York. Contrary to expectations, gender, age and socioeconomic status failed to predict patients' presurgical satisfaction with appearance. Self-concept, psychological distress, and orthodontists' ratings of total facial appearance (from a lateral view) were bivariate predictors of satisfaction. When all variables were analyzed with a multiple regression analysis, however, only self-concept emerged as a significant independent predictor of satisfaction with appearance. This accounted for 15% of the variance in satisfaction. Orthodontists' ratings of facial views, considered here objective measures of disharmony, were predictive neither of satisfaction with appearance nor of self-concept. It is suggested that self-concept may be a predictor of postsurgical as well as presurgical satisfaction with appearance and that self-concept itself may be unaffected by severity of facial disharmony, at least in young adults. Orthodontists may need to pay special attention to those patients with poor self-concept, because these patients may be more likely to report unsatisfactory surgical outcomes.
Adolescent↗
[Decision strategy in orthognathic surgery. Part 2: The esthetic choice in orthognathic surgery--practical applications].
Even if the functional factors are the most important in the decision, we have always to remember the need of our patient concerning aesthetic improvement. At this moment, the traditional approach based upon morphologic cephalometric analysis (which are frequently discordant) must be substituted by an aesthetic approach. The goal is to obtain a realistic 3D-imaging of the face as it will be after surgery. But it cannot really be achieved yet and we are obliged to work on lateral X-ray cephalograms. The most important at this stage of the decision is not to make a static aesthetic evaluation. It is on the contrary to perform a prospective simulation of the new profile line, as accurate as possible, based upon statistical correlations between soft- and hard-tissues changes. Even if there are some technical problems, even if the results are not currently good enough, the aesthetic prospective analysis allows validation or modulation of the initial functional surgical indication. We can compare for instance the aesthetic results of different amounts of displacements in bimaxillary surgery. Meanwhile, it is sure that the result depends also on the precision of the surgical procedure and on the good functional re-equilibration which is essential for the stability.
Esthetics↗
Mandibular autorotation in orthognathic surgery: a new method of locating the centre of mandibular rotation and determining its consequence in orthognathic surgery.
Rotation of the mandible is simulated through the centre of the condyle in planning orthognathic surgery. Previous studies have suggested that the initial mandibular movement is better characterized as multiple parts of the segments of a circle with the average centre located below and behind the centre of the condyle. This paper describes a method of locating the centre of mandibular rotation by computer-analysis of two lateral cephalograms with different degrees of opening. The method was used on 10 normal individuals showing an average centre of mandibular rotation 14.9 mm below and 5.0 mm behind the superior midsurface of the condyle for movements from occlusion to an opening of 10 mm. The implications of the located centre of rotation on orthognathic surgery was determined by simulating a closure of a 9.5 mm open bite. An error of up to 9.3 mm in the horizontal position of the maxilla would occur if the centre of the condyle was used. A retrospective study on 10 patients with increased anterior facial height was undertaken and a mean centre of rotation 8.4 mm behind and 25.1 mm below the centre of the condyle was found. Simulating the rotation of the mandible through the centre of the condyle would have resulted in a difference between the predicted and actual horizontal position of the maxilla ranging from 0.4-10.4 mm. It was concluded that using the centre of the condyle as the centre of mandibular rotation in the planning of superior maxillary movement with a Le Fort I osteotomy may cause considerable error in the horizontal position of the maxilla in most cases.
Cephalometry↗
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.
Adult↗
Alternative methods for reduction of blood loss during elective orthognathic surgery.
Bimaxillary orthognathic surgery and genioplasty are frequently performed to correct dentoskeletal anomalies in otherwise healthy young patients. Until 1990 homologous blood transfusions were routinely necessary for these procedures. The present study describes a protocol of blood-saving measures that was adopted and tested on a continuous sample of 127 patients treated between 1994 and 1997. The protocol comprises acute normovolemic hemodilution, controlled moderate hypotension, positioning the surgical field above the heart level, cell saving, intraoperative homeostasis, preoperative autologous blood donation, administration of recombinant erythropoietin, and acceptance of a low hematocrit perioperatively. This study shows that homologous blood transfusions may be avoided intraoperatively by following the protocol described.
Blood Loss, Surgical↗
Acoustic and perceptual analysis of the sibilant sound /s/ before and after orthognathic 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.
Adult↗
A simple classification of orthognathic surgery complications.
Although orthognathic surgery has now become a routine part of oral and maxillofacial surgery practice, the complexity of such surgery together with the detailed planning involved makes it a difficult area of surgery to follow in the literature. The plethora of literature on the subject of complications in orthognathic surgery makes it essential to devise a simple classification of complications so that comparative studies can be identified and grouped together for more meaningful interpretation. The aim of this article is to present a brief and coherent overview of the main complications associated with orthognathic surgery for the purpose of establishing a simple classification of complications for future reference.
Humans↗