Skeletal Stability after Large Mandibular Advancement (&gt; 10 mm) with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation

Schwartz, Kristoffer; Rodrigo-Domingo, Maria; Jensen, Tonny

doi:10.5037/jomr.2016.7205

Cited by 19 publications

(11 citation statements)

References 27 publications

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“…Although, the sequence of the performed osteotomies did not appear to affect post-operative relapse, this study has shown an impact of jaw translations and rotations on one-year skeletal relapse, with the magnitude of surgical displacement and skeletal relapse of the maxilla and mandible comparable to previous studies 26,27 .…”

Section: Discussionsupporting

confidence: 57%

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

Liebregts

Baan

Lierop

et al. 2019

Sci Rep

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Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.

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Section: Discussionsupporting

confidence: 57%

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

Liebregts

Baan

Lierop

et al. 2019

Sci Rep

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show abstract

“…While in one study, the change of B and Pog are measured in millimetre; others refer to changes of cephalometric angles (e.g. ANB) [ 41 ]. Furthermore, there are differences in the same measurement, depending on the imaging modality used (2D or 3D), with differences averaging > 1 mm [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, T2 was performed directly after surgery; other authors refer to a postoperative control x-ray 8 weeks after surgery. At this point, in most cases, the final splint is removed and the mostly hypertonic muscles are already actively exerting force [ 41 ]. In summary, the radiograph at T2 already represents a status deviating from the originally planned target position, so that a statement regarding the deviation from T3 is only possible to a limited extent.…”

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

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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.

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“…This tension is considered a major etiologic factor for post-operative relapse [18, 19]. The relapse rate of class II open bite after orthognathic surgery varies considerably from 1.5 to 42.9% [20–24]. Actual amount of relapse may depend on the orthodontic treatment, fixation method, intermaxillary fixation period, osteotomy design, and additional therapy such as myotomy [3–6].…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin-A injection into the anterior belly of the digastric muscle for the prevention of post-operative open bite in class II malocclusions: a case report and literature review

Kang

Kuen

Choi

et al. 2019

Maxillofac Plast Reconstr Surg

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Background Class II malocclusion patients with hyperdivergent facial types are characterized by short mandibular body lengths and anterior open bite. Accordingly, the treatment for hyperdivergent skeletal class II malocclusion is a lengthening of the mandibular body length and a counterclockwise rotation of the mandible. To prevent post-operative relapse, botulinum toxin-A (BTX-A) injection can be a retention modality. Case presentation A class II open-bite patient received BTX-A injection to the anterior belly of her digastric muscle for the prevention of post-operative relapse. The relapse was evaluated via a clinical examination and a lateral cephalometric radiograph after the completion of post-surgical orthodontic treatment. The patient showed stable occlusion without any signs of relapse at 15 months post-operatively. Conclusion In this case presentation, a single injection into the anterior belly of the digastric muscle was sufficient for the prevention of post-operative open bite.

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Skeletal Stability after Large Mandibular Advancement (> 10 mm) with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation

Cited by 19 publications

References 27 publications

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

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

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

Botulinum toxin-A injection into the anterior belly of the digastric muscle for the prevention of post-operative open bite in class II malocclusions: a case report and literature review

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