Orthognathic Surgical Outcomes in Patients With and Without Craniofacial Anomalies

Purpose The objective of this study is to examine hospitalization outcomes after orthognathic surgery. This study tests the hypothesis that patients with craniofacial anomalies have higher billed hospital charges, longer lengths of stay, and increased odds of development of infectious complications when compared with patients without craniofacial anomalies. Materials and Methods The Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients who underwent an orthognathic surgical procedure were selected. The primary independent variable of interest was presence of a congenital cleft and/or craniofacial anomaly. The outcome variables were the occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of the presence of craniofacial anomalies on outcomes. Results During the study period, a total of 16,515 patients underwent an orthognathic surgical procedure in the United States. Of these patients, 2,760 had a cleft and/or craniofacial anomaly. An infectious complication occurred in 7.4% of those with a craniofacial anomaly (compared with 0.6% of those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared with$56,189 in those without a craniofacial anomaly). The mean length of stay in the hospital in patients with a craniofacial anomaly was 8.8 days (compared with 1.8 days in those without a craniofacial anomaly). These differences in outcomes between patients with and patients without craniofacial anomalies were significant after we adjusted for patient- and hospital-level confounders. Conclusions Patients with a craniofacial anomaly are at higher risk of development of infectious complications, have higher hospital charges, and stay in the hospital for a longer duration after orthognathic surgery when compared with those without a craniofacial anomaly

Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty

Aim: The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis. Methods: The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented. Results: 113 patients had a II class dental skeletal occlusion, 180 patients had a III class dental-skeletal occlusion and 222 patients had skull-facial abnormalities. 5 patients underwent only a genioplasty, 82 patients underwent a genioplasty associated with BSSO, 175 patients underwent a genioplasty associated with Le Fort I osteotomy and the remaining 253 patients underwent a genioplasty associated with BSSO and Le Fort I osteotomy. Conclusion: The experience shows that genioplasty has been successfully introduced in orthognathic surgical therapeutic procedures, for dental-skeleton abnormalities and mandibular asymmetries treatment. In recent years, the evolution of computer systems has allowed an accurate assessment and programming, by means of the three-dimensional display, which are of great help in the course of diagnosis and evaluation of the displacements to be carried out, in order to obtain optimal aesthetic results

Let’s Face It: The effect of orthognathic surgery on facial recognition algorithm analysis

Aim: To evaluate the ability of a publicly available facial recognition application program interface (API) to calculate similarity scores for pre- and post-surgical photographs of patients undergoing orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on similarity score. Methods: Standard treatment progress photographs for 25 retrospectively identified, orthodontic-orthognathic patients were analyzed using the API to calculate similarity scores between the pre- and post-surgical photographs. Photographs from two pre-surgical timepoints were compared as controls. Both relaxed and smiling photographs were included in the study to assess for the added impact of facial pose on similarity score. Surgical procedure(s) performed on each patient, gender, age at time of surgery, and ethnicity were recorded for statistical analysis. Nonparametric Kruskal-Wallis Rank Sum Tests were performed to univariately analyze the relationship between each categorical patient characteristic and each recognition score. Multiple comparison Wilcoxon Rank Sum Tests were performed on the subsequent statistically significant characteristics. P-Values were adjusted for using the Bonferroni correction technique. Results: Patients that had surgery on both jaws had a lower median similarity score, when comparing relaxed expressions before and after surgery, compared to those that had surgery only on the mandible (p = 0.014). It was also found that patients receiving LeFort and bilateral sagittal split osteotomies (BSSO) surgeries had a lower median similarity score compared to those that received only BSSO (p = 0.009). For the score comparing relaxed expressions before surgery versus smiling expressions after surgery, patients receiving two-jaw surgeries had lower scores than those that had surgery on only the mandible (p = 0.028). Patients that received LeFort and BSSO surgeries were also found to have lower similarity scores compared to patients that received only BSSO when comparing pre-surgical relaxed photographs to post-surgical smiling photographs (p = 0.036). Conclusions: Two-jaw surgeries were associated with a statistically significant decrease in similarity score when compared to one-jaw procedures. Pose was also found to be a factor influencing similarity scores, especially when comparing pre-surgical relaxed photographs to post-surgical smiling photographs

The accuracy of three-dimensional prediction of soft tissue changes following the surgical correction of facial asymmetry: an innovative concept

The accuracy of three-dimensional (3D) predictions of soft tissue changes in the surgical correction of facial asymmetry was evaluated in this study. Preoperative (T1) and 6–12-month postoperative (T2) cone beam computed tomography scans of 13 patients were studied. All patients underwent surgical correction of facial asymmetry as part of a multidisciplinary treatment protocol. The magnitude of the surgical movement was measured; virtual surgery was performed on the preoperative scans using Maxilim software. The predicted soft tissue changes were compared to the actual postoperative appearance (T2). Mean (signed) distances and mean (absolute) distances between the predicted and actual 3D surface meshes for each region were calculated. The one-sample t-test was applied to test the alternative hypothesis that the mean absolute distances had a value of <2.0 mm. A novel directional analysis was applied to analyse the accuracy of the prediction of soft tissue changes. The results showed that the distances between the predicted and actual postoperative soft tissue changes were less than 2.0 mm in all regions. The predicted facial morphology was narrower than the actual surgical changes in the cheek regions. 3D soft tissue prediction using Maxilim software in patients undergoing the correction of facial asymmetry is clinically acceptable

Reconstruction of the adult hemifacial microsomia patient with temporomandibular joint total joint prosthesis and orthognathic surgery

HFM patients' reconstruction has always been a challenge for maxillofacial surgeons, and numerous reconstructive techniques have been described. Surgical treatment depends on the patient's age and contemplates Temporomandibular Joint (TMJ) reconstruction in conjunction with orthognathic surgery, usually necessary following completion of growth to maximize the functional and esthetic results. Distraction osteogenesis had gained popularity as valid alternative in growing patients, but the two primary methods to reconstruct the TMJs involve the use of autogenous, using free or microvascular bone grafts, or alloplastic graft, but there is no widely accepted method

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Condylar Hyperplasia: An Updated Review of the Literature

Condylar hyperplasia (CH) is a rare disorder characterized by excessive bone growth that almost always presents unilaterally, resulting in facial asymmetry. Classification of the different types of CH can differ depending on the authors. Correct diagnosis is critical in determining the proper treatments and timing. This paper is a review of the recent literature on the epidemiology, etiology, diagnosis, classification, and surgical treatments of CH

Risk factors of neurosensory disturbance following orthognathic surgery

OBJECTIVES: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery. MATERIALS AND METHODS: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo neurosensory tests with subjective and 3 objective assessments. Possible risk factors of NSD including subjects' age and gender, surgical procedures and surgeons' experience were analyzed. RESULTS: 238 patients with 476 sides were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients and surgeons' experience were not found to be risk factors of NSD after orthognathic surgery. CONCLUSION: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery.published_or_final_versio

Neurosensory and functional impairment in sagittal split osteotomies: a longitudinal and long-term follow-up study

The aim was to conduct a long-term follow-up study on the function and sensitivity of the mandible in advancement and setback patients after bilateral sagittal split osteotomy (BSSO) with rigid internal fixation. The advancement and setback groups consisted of 16 (12 females and 4 males, mean age: 21.4 and 21.3 years, respectively) and 17 (11 females and 6 males, mean age: 27.1 and 27.7 years, respectively). The final follow-up was a mean of 12.7 years (T4) post-operatively. The other follow-up examinations were before surgery (T1) and 7.3/6.6 (T2) and 13.9/14.4 (T3) months after surgery. To evaluate craniomandibular function, mouth-opening capacity, laterotrusion, protrusion, deviations during opening, pain and clicking of the temporomandibular joint (TMJ), muscular pain, and the retruded contact position-intercuspal position (RC-IP) distance were examined. A questionnaire was used to record subjective reports. The neurosensory status was determined with two-point discrimination (2-pd), the pointed, blunt, and light-touch tests. Statistical analysis included the following tests: Wilcoxon signed ranked matched pairs, Mann-Whitney U, paired t, and Fisher's exact test. Bonferroni's adjustments were made for evaluation of the questionnaire and Spearman's rank correlation coefficients to determine the interdependence of selected variables. Craniomandibular function showed restitution at T4 after 12.7 years. The 2-pd at the lip and chin had largely normalized in the two groups at T3. At T4, there was a significant increase of 2-pd at the lip and chin in both groups. The discrimination between sharp and blunt was limited in both groups in 25 per cent of patients at T4. Dysfunctions such as TMJ clicking, bruxism, and pain in the TMJ and muscles were neither increased nor decreased after BSSO. The initial post-surgical neurosensory impairment was barely detectable 1 year post-surgery. The new neurosensory impairment manifested at T4 was probably due to the normal human process of ageing. Neither age, gender, surgical advancement, nor setback showed any significant correlation