OBJECTIVETo improve the accuracy and safety of the Le Fort I osteotomy.

METHODSEighty-four patients underwent CBCT scan before maxillary orthognathic surgery. The anatomic structures of maxilla were marked and measured.

RESULTSIn 84 cases, there were 3 cases with severe hypoplasia of maxillary sinus, 11 cases with impacted third molar, 8 cases with separation in maxillary sinus, 4 cases with the deviation of nasal septum, and 3 cases with cysts in maxillary sinus. Form CBCT images, the position of the pterygopalatine canal, the thickness of maxillary wall, hidden lesion of maxillary sinus, the location of Impacted molar, the deviation of nasal septum, and other anatomic structure could be accurately localized. CBCT could provide sufficient and valuable information in diagnosis and design for Le Fort I osteotomy.

CONCLUSIONSCBCT imaging technology could provide precise anatomic images for Le Fort I osteotomy. It improves the accuracy and safety of the Le Fort I osteotomy.

Adolescent ; Adult ; Female ; Humans ; Male ; Osteotomy, Le Fort ; methods ; Tomography, X-Ray Computed ; methods ; Young Adult

OBJECTIVETo study the biomechanical characteristic of maxillary Le fort- I osteotomy with rigid internal fixation (RIF) , so as to choose best fixation method.

METHODSThe 3-dimensional finite element models of maxillary Le Fort-I osteotomy with 9 kinds of RIF methods were established. Then the models were divided into three groups to calculate the stress distribution of the maxilla and the displacement of bone segment under 3 kinds of occlusion condition. The fixation stability of the different RIF methods was evaluated.

RESULTSUnder the incisor occlusion condition, the stress of the cranio maxillary complex transmits mainly along the nasal-maxillary buttress. Under the premolar and molar occlusion condition, the stress transmits along the alveolar process first, then turns to the nasal-maxillary and zygomatic-maxillary buttress. The focused stress position of the internal fixation system is at the connection between the screws and the plate and at the plate near the osteotomy line. Under the premolar occlusion condition, the displacement of bone segment with different RIF methods was (in a decreasing order) 0.396509 mm (with bio-absorbable plate), 0.148393 mm (with micro-plate ), 0.078436 mm (with mini-plate) in group 1; 0.188791 mm (fixing at the nasal-maxillary buttress), 0.121718 mm (fixing at the zygomatic-maxillary buttress), 0.078436 mm (fixing at the both buttress) in group 2; 0.091023 mm (with straight plate), 0.078436 mm (with L shape plate), 0.072450 mm (with Y shape plate), 0.065617 mm (with T shape plate) in group 3.

CONCLUSIONSThe fixation stability of using the bio-absorbable plate in Le Fort-I osteotomy is less stable than using the titanium plate. Fixing at the zygomatic-maxillary buttress is more stable than at the naso-maxillary buttress. The fixation stability is different by using different shapes of plates.

Bone Plates ; Finite Element Analysis ; Humans ; Maxilla ; surgery ; Osteotomy, Le Fort ; methods

Chin ; surgery ; Humans ; Mandible ; surgery ; Maxillofacial Abnormalities ; surgery ; Osteotomy ; methods ; Osteotomy, Le Fort ; methods ; Tooth Abnormalities ; surgery

OBJECTIVETo probe the possibility of distraction osteogenesis for correction of mid-facial hypplasia using a new technique.

METHODSThe distraction system of mid-facial skeleton consisted of a face-bow, the elastic loops and a device that hitched to bone holes made in the aperture rim. Flllowing Le Fort III osteotomy, a bone hole was drilled at each side of the external-inferior rim of the aperture by a dental bur. The traction device was hitched to the holes through the nostrils. Distraction began three days postoperatively, with the force adjusted dependently upon the rate of progress. When the skeleton reached to the planed position, distraction was retained with a minor force for 8 weeks. Three adults with mid-facial hypoplasia underwent this treatment.

RESULTSThe mid-facial skeleton showed a balanced advancement. The patients' facial contour and occlusal relationship recovered completely.

CONCLUSIONSPatients with severe mid-facial hypoplasia could be corrected ideally by the new technique, with balanced advancement of mid-facial skeleton, minor trauma. The design of distraction system was reasonable. The manipulation of the procedure was easy.

Adult ; Face ; abnormalities ; surgery ; Female ; Humans ; Male ; Osteogenesis, Distraction ; methods ; Osteotomy, Le Fort ; methods ; Surgery, Plastic ; methods ; Treatment Outcome

OBJECTIVETo study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia.

METHODSThe three-dimensional CT reconstruction data was used with Mimics for preoperation design. The osteotomy location, distraction vector, distraction distance were decided before operation with a surgical guider. At the first stage, internal distractor was implanted after ostetomy through an extra-oral approach. The distraction begun 5-7 days after operation with a frequency of 1 mm/day. After distraction, the distractor was maintained for 3-6 months. At the second stage, the distractor was removed. Le Fort I osteotomy was performed in order to correct the cross-bite and improve the facial contour. Usually, bone graft was inserted into the gap after Le Fort I osteotomy. The genioplasty was also performed if necessary.

RESULTS9 cases of adult hemifacial microsomia with severe mandibular deviation were treated. The facial asymmetry were improved greatly. 1 patient suffered an wound infection in the maxillary region after Le Fort I osteotomy and healed uneventfully with wound irrigation.

CONCLUSIONSMandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.

Adult ; Aged ; Bone Transplantation ; Facial Asymmetry ; surgery ; Goldenhar Syndrome ; surgery ; Humans ; Mandible ; surgery ; Osteogenesis, Distraction ; methods ; Osteotomy, Le Fort ; methods

OBJECTIVETo assess the nasal airway changes after maxillary advancement following Le Fort I osteotomy.

METHODS13 cases with class III malocclusion, aged 18-35 years old, were studied prospectively. All the patients underwent Le Fort I osteotomy and maxillary advancement. Rhinological inspectrum, acoustic rhinometry (AR) were performed before operation, 3 and 6 months after operation. The Nasal Obstruction Symptom Evaluation (NOSE) scale was also completed by 13 patients before and after operation. SPSS was used for statistical assay.

RESULTSAR assessment showed that NAR was (1.189 +/- 0.38) cm H2O/L/mi, (1.081 +/- 0.43) cm H2O/L/mi and (1.111 +/- 0.40) cm H2O/L/mi before operation, 3 and 6 months after operation; NV was (14.920 +/- 1.95) ml, (16.380 +/- 4.32) ml and (15.660 +/- 4.25) ml; and MCA was (0.500 +/- 0.09) cm2, (0.570 +/- 0.15) cm2 and (0.560 +/- 0.14) cm2, respectively. However, no significant improvement was showed. For the whole cohort, significant improvement in nasal breathing was documented (by NOSE scores) at 6 months after surgery.

CONCLUSIONSLe Fort I osteotomy with maxillary advancement doesn't cause bad effect on nasal airways in patients with maxillary dysplasia. And the combination of objective (AR) and subjective (NOSE scale) assessment can better evaluate of the structure and function of the nose.

Adolescent ; Adult ; Female ; Humans ; Male ; Maxilla ; surgery ; Nose ; physiopathology ; Osteotomy, Le Fort ; methods ; Postoperative Period ; Respiration ; Young Adult

BACKGROUND: Numerous condylar repositioning methods have been reported. However, most of them are 2-dimensional or are complex procedures that require a longer operation time and a highly trained surgeon. This study aims to introduce a new technique using a condylar repositioning plate and a centric relation splint to achieve a centric relationship. METHODS: We evaluated 387 patients who had undergone surgery for skeletal jaw deformities. During the operation, a centric relation splint, intermediate splint, final centric occlusion splint, and condylar repositioning plate along with an L-type mini-plate for LeFort I osteotomy or a bicortical screw for bilateral sagittal split ramus osteotomy were utilized for rigid fixation. The evaluation included: a physical examination to detect preoperative and postoperative temporomandibular joint dysfunction, 3-dimensional computed tomography and oblique transcranial temporomandibular joint radiography to measure 3-dimensional condylar head movement, and posteroanterior and lateral cephalometric radiography to measure the preoperative and postoperative movement of the bony segment and relapse rate. RESULTS: A 0.3% relapse rate was observed in the coronal plane, and a 2.8% relapse rate in the sagittal plane, which is indistinguishable from the dental relapse rate in orthodontic treatment. The condylar repositioning plate could not fully prevent movement of the condylar head, but the relapse rate was minimal, implying that the movement of the condylar head was within tolerable limits. CONCLUSIONS: Our condylar repositioning method using a centric relation splint and mini-plate in orthognathic surgery was found to be simple and effective for patients suffering from skeletal jaw deformities.
Centric Relation ; Congenital Abnormalities ; Head ; Head Movements ; Humans ; Jaw ; Methods ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Physical Examination ; Radiography ; Recurrence* ; Splints ; Temporomandibular Joint

PURPOSE: The purpose of this study was to measure the anteroinferior changes and the degree of vertical changes to facilitate the prediction of treatment outcome in patients undergoing genioplasty only, genioplasty with bilateral sagittal split ramus osteotomy (BSSRO), genioplasty, or BSSRO and Lefort I osteotomy. MATERIALS AND METHODS: Serial cephalometry was performed on 25 patients at 1-year follow-up after genioplasty, to assess skeletal changes and relapse. Surgery was performed using conventional techniques. RESULTS: The mean ratio was 0.9 : 1 of soft tissue to skeletal movement at pogonion, but the average difference between hard and soft tissue was large; thus, the prediction of anteroposterior soft tissue changes was quite inaccurate. CONCLUSION: We observed a good correlation between the amount of hard versus soft tissue change with surgery in the horizontal direction, but a poor correlation in the vertical plane.
Adolescent ; Adult ; Female ; Humans ; Male ; Malocclusion, Angle Class III/pathology/*surgery ; Mandible/pathology/*surgery ; Osteotomy/methods ; Osteotomy, Le Fort/methods ; Reconstructive Surgical Procedures/*methods ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the clinical application of mandibular-driven simultaneous maxillo-mandihular distraction to correct hemifacial microsomia with rapid prototyping technology.

METHODSThe patient' s skull resin model was manufactured with rapid prototyping technology. The osteotomy was designed on skull resin model. According to the preoperative design, the patients underwent Le Fort I osteotomy and mandibular ramus osteotomy. The internal mandible distractor was embedded onto the osteotomy position. The occlusal titanium pin was implanted. Distraction were carried out by mandibular-driven simultaneous maxillo-mandihular distraction 5 days after operation.

RESULTSThe distraction in five patients was complete as designed. No infection and dysosteogenesis happened. The longest distance of distraction was 28 mm, and the shortest distance was 16 mm. The facial asymmetry deformity was significantly improved at the end of distraction. The ocelusal plane of patients obviously improved.

CONCLUSIONSRapid prototyping technology is helpful to design precisely osteotomy before operation. Mandibular-driven simultaneous maxillo-mandibular distraction can correct hemifacial microsomia. It is worth to clinical application.

Face ; abnormalities ; surgery ; Facial Asymmetry ; congenital ; surgery ; Goldenhar Syndrome ; surgery ; Humans ; Hyperplasia ; surgery ; Mandible ; surgery ; Maxilla ; surgery ; Osteogenesis, Distraction ; methods ; Osteotomy ; methods ; Osteotomy, Le Fort

OBJECTIVETo investigate the result of zygomatic reduction with midface L-shaped osteotomy through intraoral approach.

METHODSFrom June 2006 to Aug. 2009, 67 cases received zygomatic reduction with midface L-shaped osteotomy through intraoral approach. 52 cases underwent CT scan before operation and 12 months after operation. The images were analyzed by software GE AW 4.1 for evaluation of clinical effect, maxillary sinus change and complication. SAS 6.12 software was applied for one-way ANOVA.

RESULTSSatisfactory results were achieved in all the patients. The volume of maxillary sinus at left and right side was (21233.96 +/- 4455.04) mm3, and (22020.64 +/- 3663.82) mm3, respectively before operation: (17840.91 +/- 4381.03) mm3 and (18511.85 +/- 3466.24) mm3 respectively 12 months after operation, showing a significant difference between them (P<0.05). No infection or dental pulp necrosis happened.

CONCLUSIONSGood results can be achieved with intraoral L-shaped osteotomy for zygomatic reduction. Exposure of maxillary sinus would not cause any complication.

Adult ; Female ; Humans ; Male ; Maxillary Sinus ; Osteotomy, Le Fort ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Reconstructive Surgical Procedures ; methods ; Young Adult