Modern Surgery-First Approach Concept in Cleft-Orthognathic Surgery: A Comparative Cohort Study with 3D Quantitative Analysis of Surgical-Occlusion Setup

et al. 2020

JCM

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Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p < 0.001) and maxillary rotation (all p < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3–4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all p > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.

Section: Orthognathic Surgery Treatmentmentioning

confidence: 99%

Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

Lai

et al. 2020

JCM

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“…Since no prior investigation employed the FACE-Q questionnaire and 3D morphometry for analysis of a cohort of patients, we could not perform a direct comparative appraisal of the current versus former findings. The generalizability of our findings cannot be assumed, as all included patients were treated by particular procedural strategies, including the digital occlusion set up, virtual surgery, surgeryfirst model, and two-jaw orthognathic surgery with single-splint technique 3,[45][46][47][48][49] . We enrolled a restricted final sample as only matched patients and controls were included for analysis.…”

Section: Discussionmentioning

confidence: 99%

“…No postoperative intermaxillary fixation was adopted and the orthodontic therapy was initiated 2 to 4 weeks post-operatively. Full descriptions of the standard pre-and post-surgical treatment principles and details used in this center has previously been published 3,[45][46][47][48] . FACE-Q instrument.…”

Section: Skeletofacial Reconstructive Approach All Patients Underwenmentioning

confidence: 99%

Patient- and 3D morphometry-based nose outcomes after skeletofacial reconstruction

Chou

Seo

et al. 2020

Sci Rep

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Patient satisfaction with the shape and appearance of their nose after orthognathic surgery-based skeletofacial reconstruction is an important, but often overlooked, outcome. We assessed the nose-related outcomes through a recently developed patient-reported outcome instrument and a widely adopted 3D computer-based objective outcome instrument, to verify any correlation in the results produced by these tools. We collected FACE-Q nose appearance reports (2 scales) and 3D nasal morphometry (10 parameters) from patients with class III skeletal pattern and congenital cleft lip palate deformity (n = 23) or developmental dentofacial deformity (n = 23) after (>12 months) skeletofacial reconstruction. The cleft and dentofacial cohorts demonstrated significantly (p < 0.001) poorer satisfaction scores with regard to the FACE-Q nostrils scale than the normal age-, gender-, and ethnicity-matched subjects (n = 107), without any significant difference in FACE-Q nose scale. The cleft cohort had significantly (p < 0.001) smaller nasal length, nasal tip projection, and columellar angle and greater nasal protrusion, alar width, and columellar-labial angle values than the dentofacial and normal cohorts; however, there were no significant differences between the dentofacial versus normal cohorts. The FACE-Q nose and nostrils scales were significantly (p < 0.001; r = −0.26-0.27) correlated to the results of the 3D morphometric analysis, with regard to nasal length, alar width, columella angle, and columellar-labial angle parameters. This study revealed differences in satisfaction with the appearance of the nose according to the type of underlying deformity, and demonstrated a significant correlation (low correlation coefficients) between the patient-reports and 3D image-based outcome measure tools, which has implications for multidisciplinary-centered research, auditing, and clinical care. Facial deformities associated with abnormal maxillo-mandibular relationships, such as congenital cleft lip and palate and developmental dentofacial deformities, significantly affect oral function and facial aesthetics 1,2. Skeletofacial reconstruction using orthognathic surgery principle is a successful treatment modality for these abnormalities 3-5. However, a number of post-surgical facial modifications are the primary causes of concern among the patients, particularly changes in the nasal morphology 6. A growing number of studies have addressed this issue by adopting three-dimensional (3D) nasal measurements 6-15 , but the effects of skeletofacial reconstruction are beyond these imaging-guided outcome metrics 1,4,5. The patient satisfaction with the appearance of their nose is an important, albeit often overlooked, outcome parameter after orthognathic surgery. Therefore, including a patient's self-perception by employing patient-reported outcome (PRO) techniques may help clinicians to understand the health-related concerns of the patient 16,17. Literature reviews 4,5 have revealed that a plethora of PRO instruments have been utilized to primaril...

“…For both 2D planning and 3D simulation groups, the average follow-up period was longer than 12 months, with the minimum time criteria for acquisition of facial photographic images to mitigate potential problems related to facial soft tissue swelling 43 . The involved patients had differences (mean of 3 months) for postoperative follow up parameter as it was related to the time required for orthodontic adjustment before debonding and it is broadly variable from patient to patient in different cohorts 44,45 . Our findings demonstrated that both groups…”

Section: Discussionmentioning

confidence: 99%

Outcome of facial contour asymmetry after conventional two-dimensional versus computer-assisted three-dimensional planning in cleft orthognathic surgery

Hsu

Pai

et al. 2020

Sci Rep

Self Cite

Computer-assisted 3D planning has overcome the limitations of conventional 2D planning-guided orthognathic surgery (OGS), but difference for facial contour asymmetry outcome has not been verified to date. This comparative study assessed the facial contour asymmetry outcome of consecutive patients with unilateral cleft lip and palate who underwent 2D planning (n = 37)-or 3D simulation (n = 38)-guided OGS treatment for correction of maxillary hypoplasia and skeletal Class III malocclusion between 2010 and 2018. Normal age-, gender-, and ethnicity-matched individuals (n = 60) were enrolled for comparative analyses. 2D (n = 60, with 30 images for each group) and 3D (n = 43, with 18 and 25 images for 2D planning and 3D simulation groups, respectively) photogrammetric-based facial contour asymmetry-related measurements were collected from patients and normal individuals. The facial asymmetry was further verified by using subjective perception of a panel composed of 6 blinded raters. On average, the facial contour asymmetry was significantly (all p < 0.05) reduced after 3D virtual surgery planning for all tested parameters, with no significant differences between post-OGS 3D simulation-related values and normal individuals. No significant differences were observed for pre-and post-OGS values in conventional 2D planning-based treatment, with significant (all p < 0.05) differences for all normal individuals-related comparisons. This study suggests that 3D planning presents superior facial contour asymmetry outcome than 2D planning.Orthognathic surgery (OGS) plays a key role for successful management of a myriad of facial deformities associated with malocclusion, with facial asymmetry feature being most frequently associated with skeletal class III malocclusion 1-3 . Particularly, patients with unilateral cleft lip and palate differ from the noncleft population, because they have a congenital orofacial defect compromising both the bone and soft tissues on the lesion side 4-6 , which may be expressed as facial asymmetry 7-15 . Skeletal mature patients with clefts frequently presents with maxillomandibular disharmony (maxillary hypoplasia and skeletal class III malocclusion) which requires OGS treatment 7-15 . As residual facial asymmetry after OGS treatment may negatively impact patients' perceptions about outcome requiring further revisionary surgical interventions [16][17][18][19] , the significance of preoperative prediction of this deformity should not be underestimated 15,16,20 . Therefore, it is of paramount that an accurate diagnosis of asymmetry is accomplished preoperatively for that a precise surgical planning and execution is performed 7,15,16,20 .In this setting, OGS planning has evolved over the past decades 15-24 . Traditionally, OGS planning has been constructed on two-dimensional (2D) cephalometry, 2D photographic analysis, articulators, and dental models 21,22 . However, this planning modality presents limitations for challenging clinical scenarios such as patients with clefts associated with malocclusion a...