One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

Liebregts, Jeroen; Baan, Frank; Lierop, Pieter van; Koning, Martien de; Bergé, Stefaan; Maal, T.J.J.; Xi, Tong

doi:10.1038/s41598-019-39250-x

Cited by 22 publications

(17 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Skeletal stability after orthognathic surgery is controversially discussed in the literature and it was shown that postsurgical relapse mainly develops within the first 6 months after surgery [ 33 ]. Late relapse on the other hand tends to develop from 6 to 12 months after surgery and is believed to occur due to individual patient characteristics, such as condylar resorption as well as type, direction and magnitude of surgical displacements [ 34 , 35 ]. However, little is known about long-term stability after orthognathic surgery.…”

Section: Discussionmentioning

confidence: 99%

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery—a retrospective, cross-sectional long-term analysis

Thiem

Schneider

Hammel³

et al. 2020

Clin Oral Invest

View full text Add to dashboard Cite

Objectives The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. Materials and Methods In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0–4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. Results Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients’ self-perception (85.4%), with 60.4% of patients opting for surgery again. Conclusions Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. Clinical relevance Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery—a retrospective, cross-sectional long-term analysis

Thiem

Schneider

Hammel³

et al. 2020

Clin Oral Invest

View full text Add to dashboard Cite

show abstract

“…The OrthoGnathicAnalyser (OGA), as described in our previous study [ 11 ], was identified as the 3D assessment tool of choice, due to the application of VBM and the semi-automatic approach. Over time, the OGA has already been applied in large clinical studies [ 12 , 13 ], demonstrating its clinical applicability.…”

Section: Introductionmentioning

confidence: 99%

Validation of the OrthoGnathicAnalyser 2.0—3D accuracy assessment tool for bimaxillary surgery and genioplasty

et al. 2021

Self Cite

View full text Add to dashboard Cite

Orthognathic surgery is a widely performed procedure to correct dentofacial deformities. Virtual treatment planning is an important preparation step. One advantage of the use of virtual treatment planning is the possibility to assess the accuracy of orthognathic surgery. In this study, a tool (OrthoGnathicAnalyser 2.0), which allows for quantification of the accuracy of orthognathic surgery, is presented and validated. In the OrthoGnathicAnalyser 2.0 the accuracy of the osseous chin can now be assessed which was not possible in the earlier version of the OrthoGnathicAnalyser. 30 patients who underwent bimaxillary surgery in combination with a genioplasty were selected from three different centers in the Netherlands. A pre-operative (CB)CT scan, virtual treatment planning and postoperative (CB)CT scan were required for assessing the accuracy of bimaxillary surgery. The preoperative and postoperative (CB)CT scans were aligned using voxel-based matching. Furthermore, voxel-based matching was used to align the pre-operative maxilla, mandible and rami towards their postoperative position whereas surface-based matching was used for aligning the pre-operative chin towards the postoperative position. The alignment resulted in a transformation matrix which contained the achieved translations and rotations. The achieved translations and rotations can be compared to planning values of the virtual treatment plan. To study the reproducibility, two independent observers processed all 30 patients to assess the inter-observer variability. One observer processed the patients twice to assess the intra-observer variability. Both the intra- and inter-observer variability showed high ICC values (> 0.92) and low measurement variations (< 0.673±0.684mm and < 0.654±0.824°). The results of this study show that the OrthoGnathicAnalyser 2.0 has an excellent reproducibility for quantification of skeletal movements between two (CB)CT scans.

show abstract

“…Both studies were planned using articulator models, and the relapse was measured by 2-dimensional lateral cephalometric tracing. Only Liebregts et al 6 have evaluated the overall 3-dimensional (3D) relapse for orthognathic surgery patients, but no study has specifically evaluated 3D relapse or skeletal stability in inferior maxillary repositioning. 7 The new 3D semi-automatic technique can be used to measure skeletal stability and relapse independent of postoperative orthodontic treatment.…”

Section: Introductionmentioning

confidence: 99%

Inferior Maxillary Repositioning Remains Stable 1 Year After Surgery but Entails a High Risk of Osteosynthesis Failure

Stokbro

Thygesen

Marcussen

2020

Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

Purpose: Inferior maxillary repositioning is among the most unstable orthognathic procedures. The overall purpose of this study was to measure skeletal stability after inferior maxillary repositioning.Method: The authors implemented a retrospective cohort study. The study cohort was derived from all orthognathic patients treated between January 2011 and December 2013 in Odense University Hospital. Inclusion criteria were orthognathic surgery with inferior maxillary reposition in patients with no maxillary segmentation or cleft lip/palate. Exclusion criteria were non-attendance at followup or requiring reoperation before the 1-year follow-up. The primary predictor variable was the time from 1-week follow-up to 1-year follow-up. The primary outcome variable was maxillary skeletal movement. Other variables of interest were age, sex, preoperative occlusal relationship, obtained maxillary movement, and type of surgery (mono-or bimaxillary procedure). Skeletal stability was measured at the centroid, anterior, and posterior nasal spines using the semi-automatic measurement technique. Skeletal stability was clinically defined as less than 2 mm movement in any direction. Positive directions of the 3 axes were right, anterior, and superior. The data were analyzed by mixed model linear regression analysis and 1-sample t-tests.Results: In total, 17 patients were included in the study (mean age 28, 35% female, 59% bimaxillary surgeries). Inferior maxillary repositioning was stable with less than 0.3 mm mean skeletal movement in any direction. Only 1 patient had a relapse of more than 1 mm in the posterior direction and none exceeded 2 mm. However, 3 patients were excluded from this analysis, since they required reoperation during the first year after surgery due to osteosynthesis failure. Conclusion:Inferior maxillary repositioning was stable during the first year after surgery; however, there was a high complication rate (15%). Thus, this procedure may still benefit from use of more rigid patient-specific, printed plates to increase postoperative stability.

show abstract

One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

Cited by 22 publications

References 37 publications

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery—a retrospective, cross-sectional long-term analysis

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery—a retrospective, cross-sectional long-term analysis

Validation of the OrthoGnathicAnalyser 2.0—3D accuracy assessment tool for bimaxillary surgery and genioplasty

Inferior Maxillary Repositioning Remains Stable 1 Year After Surgery but Entails a High Risk of Osteosynthesis Failure

Contact Info

Product

Resources

About