The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.
Face/surgery* ; Facial Bones ; Humans ; Maxillofacial Abnormalities ; Orthognathic Surgery ; Orthognathic Surgical Procedures

OBJECTIVES: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. MATERIALS AND METHODS: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. RESULTS: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. CONCLUSION: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.
Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Esthetics ; Facial Injuries ; Facial Muscles ; Fracture Fixation, Internal ; Frontal Bone ; Human Body ; Incidence ; Nose ; Oral and Maxillofacial Surgeons ; Osteotomy ; Paresthesia ; Rhinoplasty ; Surgery, Oral

BACKGROUND: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. METHODS: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. RESULTS: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. CONCLUSIONS: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.
Chin ; Congenital Abnormalities ; Equidae ; Glenoid Cavity ; Humans ; Jaw ; Joints ; Mandible ; Mandibular Condyle ; Mandibular Osteotomy ; Maxilla ; Methods ; Oral and Maxillofacial Surgeons ; Orbit ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Surgery, Oral ; Temporomandibular Joint

OBJECTIVES: The role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery. MATERIALS AND METHODS: Thirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas. RESULTS: The outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy. CONCLUSION: Based on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.
Chin ; Congenital Abnormalities ; Humans ; Maxillofacial Prosthesis Implantation ; Polyethylene* ; Prefrontal Cortex ; Reconstructive Surgical Procedures

Binder syndrome is a rare maxillofacial abnormality. Yet, once presented, it often needs to be addressed surgically. To suit this purpose, various surgical techniques have been developed. This paper is a case report of a staged nasal reconstruction in a Binder syndrome patient using rib bone and cartilage graft and forehead flap. At the same time, preoperative and postoperative anthropomorphometric measurements were compared to assess the efficiency of the proposed surgical technique.
Cartilage* ; Forehead* ; Humans ; Maxillofacial Abnormalities ; Nose ; Ribs* ; Transplants*

OBJECTIVETo analyze a child with facial abnormalities with combined cytogenetic and molecular techniques and delineate its clinical phenotype.

METHODSNeuropsychological profile of the child was analyzed. Color Doppler, CT and MRI were used for detecting the nodules in the body. Conventional peripheral blood karyotypes of the child and his parents were analyzed with G-banding. Array-comparative genomic hybridization (aCGH) was performed to detect minor structural chromosomal abnormalities.

RESULTSThe child had mental retardation, maxillofacial dysmorphism on the right side, and irregular solid nodules on the back. The karyotypes of the child and his parents were all normal, while aCGH has identified a de novo constitutive 1.2 Mb deletion at 17q11.2 in the child. The aCGH results of his parents were normal.

CONCLUSIONThe de novo 17q11.2 microdeletion probably underlies the facial abnormalities and neurofibromatosis in the patient.

Child, Preschool ; Chromosome Banding ; Chromosome Deletion ; Chromosomes, Human, Pair 17 ; genetics ; Comparative Genomic Hybridization ; Humans ; Intellectual Disability ; genetics ; Karyotyping ; Male ; Maxillofacial Abnormalities ; genetics ; Phenotype ; Smith-Magenis Syndrome ; genetics

Maxillofacial defect comes from congenital defect, trauma and surgical resection. Patients with intraoral defect are commonly related to maxillary defect and they need prosthetic rehabilitation. Functional reconstruction of partially edentulous mandible has many limitations. However, if both condyles are intact, maxillofacial prosthesis using partial denture give competent results. In this case, a patient of 58 year-old male has a defect on palate and left mandibular posterior teeth from gunshot. The maxillary defect of this patient is Class IV according to Aramany classification and the mandibular one is Type V according to Cantor and Curtis classification. For retention of the obturator, remaining teeth are fully utilized and artificial teeth are arranged harmoniously to provide stable occlusion. Mandibular RPD covered limited range of deformed soft tissue derived from mandibular resection surgery. With these treatments, the patient in this case showed improvements in mastication, swallowing and speech.
Classification ; Congenital Abnormalities ; Deglutition ; Denture, Partial ; Denture, Partial, Removable ; Humans ; Male ; Mandible ; Mastication ; Maxillofacial Prosthesis ; Palate ; Rehabilitation* ; Tooth ; Tooth, Artificial

PURPOSE: The purpose of this study was to investigate the demographic patterns of maxillofacial prosthetic treatment to identify the characteristics and geographic distribution of patients with maxillofacial prosthetics in the capital region of Korea. MATERIALS AND METHODS: This retrospective analytical multicenter study was performed by chart reviews. This study included patients who visited the department of prosthodontics at four university dental hospitals for maxillofacial prosthetic rehabilitation. Patients with facial and congenital defects or with insufficient medical data were excluded. The patients were classified into three categories based on the location of the defect. Patients' sex, age, and residential area were analyzed. Pearson's chi-square test with a significance level of 0.05 was used to analyze the variables. RESULTS: Among 540 patients with maxillofacial prosthetics, there were 284 (52.59%) male patients and 256 (47.41%) female patients. The number of the patients varied greatly by hospital. Most patients were older than 70, and the most common defect was a hard palate defect. Chi-square analysis did not identify any significant differences in sex, age, and distance to hospital for any defect group (P>.05). CONCLUSION: The results of this study indicated that there was imbalance in the distribution of patients with maxillofacial prosthetic among the hospitals in the capital region of Korea. Considerations on specialists and insurance policies for the improvement of maxillofacial prosthetics in Korea are required.
Congenital Abnormalities ; Female ; Head and Neck Neoplasms ; Humans ; Insurance ; Korea* ; Male ; Mandibular Prosthesis ; Maxillofacial Prosthesis ; Palatal Obturators ; Palate, Hard ; Prosthodontics ; Rehabilitation ; Retrospective Studies ; Specialization ; Velopharyngeal Insufficiency

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.
Congenital Abnormalities ; Head* ; Humans ; Mandible ; Maxilla ; Methods* ; Oral and Maxillofacial Surgeons ; Orthognathic Surgery

Cleft Lip ; complications ; Cleft Palate ; complications ; Humans ; Maxillofacial Abnormalities ; pathology ; Orthodontics, Corrective