An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery

Abstract

Bimaxillary orthognathic surgery has been widely performed to achieve optimal functional and esthetic outcomes in patients with dentofacial deformity. Although Le Fort I osteotomy is generally performed before bilateral sagittal split osteotomy (BSSO) in the surgery, in several situations BSSO should be performed first. However, it is very difficult during bimaxillary orthognathic surgery to maintain an accurate centric relation of the condyle and decide the ideal vertical dimension from the skull base to the mandible. We have previously applied a straight locking miniplate (SLM) technique that permits accurate superior maxillary repositioning without the need for intraoperative measurements in bimaxillary orthognathic surgery. Here we describe the application of this technique for accurate bimaxillary repositioning in a mandible-first approach where the SLMs also serve as a condylar positioning device in bimaxillary orthognathic surgery.

Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia

“…1). 14,15 The SLM technique is a simple method of accurate maxillary superior repositioning with no intraoperative measurement. Using it, surgical precision and stable fixation are possible.…”

Condylar positioning in orthognathic surgery

“…Several methods and devices to control the positioning of the proximal segment have been suggested over the years 8 with good results [9][10][11][12][13][14][15][16][17][18] or not 19,20 , maintaining unanswered questions on this topic 21 . There is no scientific evidence supporting the routine use of condylar positioning devices (CPD) in orthognathic surgery 19,22 .…”

“…In this context, there is no scientific evidence that desired postoperative condilar position is the same pre-operative condylar position, and there are many reasons for this 17 . However, it seems to be acceptable that if there aren't pre-operative signs and symptoms of TMJ problems, the pre-operative condyle position is good and it is desired in the postoperative moment.…”

A Novel Orthognathic Surgery With a Half-Millimeter Accuracy for the Maxillary Positioning Using Prebent Plates and Computer-Aided Design and Manufacturing Osteotomy Guide

“…[1][2][3][4][5][6] However, the use of the CAD/CAM intermediate splint for maxillary surgery has often caused some errors because of the mobility of the mandible and temporomandibular joint, particularly in patients with unstable condyle-fossa relations and repeated intraoperative measurement for maxillary repositioning. [7][8][9] Therefore, the accuracy of CAD/CAM-guided surgery remains to be determined, although it is obviously more accurate than traditional surgery. We previously reported a simple technique using a straight locking miniplate (SLM) for accurate maxillary repositioning without any intraoperative measurement.…”

“…We previously reported a simple technique using a straight locking miniplate (SLM) for accurate maxillary repositioning without any intraoperative measurement. 8,9 As the SLM technique defines the relationship between the maxilla and mandible during surgery, the combination of SLM and CAD/CAM intermediate splints reflects the virtual surgical planning during surgery as a simplified. Accordingly, a comparison of this simplified maxillomandibular relation reproducible method, SLM technique, with fully guided surgery with osteotomy and plating guide could precisely evaluate the accuracy of the guided surgery because both methods use a CAD/CAM-based intermediate splint.…”