BACKGROUND: Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). METHODS: Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. RESULTS: The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1degrees before surgery, and increased to 2.5degrees after surgery. The mean nasolabial angle was 72.7degrees before surgery, and increased to 88.7degrees after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. CONCLUSIONS: Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.
Cleft Lip ; Humans ; Lip ; Mandible ; Maxilla ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Palate

INTRODUCTION: This study evaluate the soft tissue changes to the upper lip and nose after Le Fort I maxillary posterosuperior rotational movement. MATERIALS AND METHODS: Twenty Skeletal class III patients, who had undergone bimaxillary surgery with a maxillary Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included in the study. The surgical plan for maxilla was posterosuperior rotational movement, with the rotation center in the anterior nasal spine (ANS) of maxilla. Soft and hard tissue changes were measured by evaluating the lateral cephalograms obtained prior to surgery and at least 6 months after surgery. For cephalometric analysis, four hard tissue landmarks ANS, posterior nasal spine [PNS], A point, U1 tip), and five soft tissue landmarks (pronasale [Pn], subnasale [Sn], A' Point, upper lip [UL], stomion superius [StmS]) were marked. A paired t test, Pearson's correlation analysis and linear regression analysis were used to evaluate the soft and hard tissue changes and assess the correlation. A P value <0.05 was considered significant. RESULTS: The U1 tip moved 2.52+/-1.54 mm posteriorly in the horizontal plane (P<0.05). Among the soft tissue landmarks, Pn moved 0.97+/-1.1 mm downward (P<0.05), UL moved 1.98+/-1.58 mm posteriorly (P<0.05) and 1.18+/-1.85 mm inferiorly (P<0.05), and StmS moved 1.68+/-1.48 mm posteriorly (P<0.05) and 1.06+/-1.29 mm inferiorly (P<0.05). The ratios of horizontal soft tissue movement to the hard tissue were 1:0.47 for the A point and A' point, and 1:0.74 for the U1 tip and UL. Vertically, the movement ratio between the A point and A' point was 1:0.38, between U1 tip and UL was 1:0.83, and between U1 tip and StmS was 1:0.79. CONCLUSION: Posterosuperior rotational movement of the maxilla in Le Fort I osteotomy results in posterior and inferior movement of UL. In addition, nasolabial angle was increased. Nasal tip and base of the nose showed a tendency to move downward and showed significant horizontal movement. The soft tissue changes in the upper lip and nasal area are believed to be induced by posterior movement at the UL area.
Cephalometry ; Humans ; Linear Models ; Lip ; Maxilla ; Nose ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Spine

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

OBJECTIVETo evaluate the effect of orthognathic surgery in the treatment of condylar osteochondroma.

METHODSA total of 12 cases of condylar osteochondroma were treated with Le Fort I osteotomy, intraoral vertical ramus osteotomy, sagittal split ramus osteotomy and genioplasty.

RESULTSNo recurrence of condylar osteochondroma was observed in all 12 cases two years after the treatments. Facial asymmetry was obviously corrected.

CONCLUSIONThe orthognathic surgery methods are advantageous in improving facial figure without scar development in the treatment of condylar osteochondroma.

Bone Neoplasms ; Face ; abnormalities ; Facial Asymmetry ; congenital ; Humans ; Hyperplasia ; Male ; Orthognathic Surgery ; Osteochondroma ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus

bone reduction procedures for the correction of the prominent mandibular angle, we collected and sorted the methods. The strength and weakness, indication, complication, and final esthetic result of each method were evaluated. After searching and filtering the literatures on the base of inclusion criteria, 9 eligible case series studies were included in this study. There were 3 types of curved ostectomies and 4 types of lateral cortical ostectomies. Surgical procedures for curved ostectomies were divided into 2 types. One was single curved ostectomy and the other was multistaged curved ostectomy. Lateral cortical ostectomies reported were all similar to sagittal split ramus osteotomy. The complications reported in the included studies were scarce, but curved ostectomies may be able to induce many complications. The prominent mandibular angle must be analyzed in the lateral dimension and frontal dimension, and curved ostectomy can reduce the mandibular angle laterally while lateral cortical ostectomy can reduce the bigonial distance frontally. Because curved ostectomies can induce complications and unnaturally large mandibular angle while can not reduce bigonial distance efficiently, the current trend for the angle reduction procedure is lateral cortical ostectomies.]]>
Mandible ; Osteotomy, Sagittal Split Ramus

OBJECTIVE: We compared the skeletal and dental changes that resulted from the use of two methods of intermaxillary fixation (IMF)-miniscrews and surgical archwire-in 74 adult patients who had Class III malocclusion and were treated with the same orthognathic surgical procedure at a hospital in Korea. METHODS: All the patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with rigid fixation. They were divided into two groups according to the type of IMF used-group 1 underwent surgical archwire fixation and group 2 underwent orthodontic miniscrew fixation. In a series of cephalograms for each patient, we compared vertical and horizontal tooth-position measurements: (a) immediately after surgery (T0), (b) 3 months after surgery (T1), and (c) 6 months after surgery (T2). Cephalometric changes within each group were examined using one-way analysis of variance (ANOVA) while the independent samples t-test procedure was used to compare the two groups. RESULTS: After surgery, the maxillary incisors tended to be proclined in both groups although there were no significant differences. Incisor overbite increased significantly in both groups from T0 to T1, and the miniscrew group (group 2) showed slightly greater overbite than the archwire group (group 1). CONCLUSIONS: This study suggest that the use of orthodontic miniscrews and orthodontic surgical archwire for IMF in adult patients results in similar skeletal and dental changes.
Adult* ; Humans ; Incisor ; Korea ; Malocclusion ; Orthognathic Surgery* ; Orthognathic Surgical Procedures ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Overbite

OBJECTIVES: To evaluate the influence of the type of osteotomy in the inferior aspect of the mandible on the mechanical performance. MATERIALS AND METHODS: The study was performed on 20 polyurethane hemimandibles. A sagittal split ramus osteotomy (SSRO) was designed in 10 hemimandibles (group 1) with a vertical osteotomy in the buccal side (second molar level) and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. For group 2, the same osteotomy technique was used, but an oblique osteotomy was done in the basilar aspect of the mandibular body, forming continuity with the sagittal cut in the basilar area. Using a surgical guide, osteosynthesis was performed with bicortical screws using an inverted L scheme. In both groups vertical compression tests were performed with a linear load of 1 mm/min on the central fossa of the first molar and tests were done with models made from photoelastic resin. Data were analyzed using Student's t-test, establishing a statistical significance when P <0.05. RESULTS: A statistical difference was not observed in the maximum displacements obtained in the two osteotomies (P <0.05). In the extensiometric analysis, statistically significant differences were identified only in the middle screw of the fixation. The photoelastic resin models showed force dissipation towards the inferior aspect of the mandible in both SSRO models. CONCLUSION: We found that osteotomy of the inferior aspect did not influence the mechanical performance for osteosynthesis with an inverted L system.
Mandible ; Mandibular Osteotomy ; Molar ; Osteotomy ; Osteotomy, Sagittal Split Ramus* ; Polyurethanes

sagittal split ramus osteotomy for mandibular setback in 15 patients by paired t-test. We used oblique transcranial radiographs taken before operation and immediate after operation. And we concluded as follows; 1. The joint spaces changed under 0.2mm were 21.2%, 0.2mm to 1.0mm were 67.7%, above 1.0mm were 11.1%. 2. The mean changes of AJS, SJS, PJS were all increased and SJS was most changed of them, but there is no statistically significant change in SJS. 3. Comparing the preop. measurements with the postop. ones, there is no statistically significant changes in over all joint spaces (P> 0.05)]]>
Humans ; Joints ; Osteotomy, Sagittal Split Ramus

sagittal split ramus osteotomy.METHODS: Thirty patients with class III dental and skeletal malocclusion and who were treated with BSSRO were reviewed. Three plain radiographs such as the panoramic view, the lateral cephalogram and the submentovertex view were taken before and after operation. Also, paper surgery for STO and model surgery were used to evaluate the amount of mandibular set back.RESULTS: On the panoramic view, the amount of mandibular set back in STO was similar to the postoperative results of model surgery, but the amount of mandibular set back on the lateral cephalogram was smaller than the postoperative result of model surgery and then the amount of set back on submentovertex view was similar to the postoperative result of model surgery.CONCLUSION: Precise tracing and paper surgery should be performed for a combined expected STO in order to predict the exact amount of preoperative mandibular set back.]]>
Humans ; Jaw ; Malocclusion ; Osteotomy, Sagittal Split Ramus

OBJECTIVETo evaluate the short-term and long-term effects of pharyngeal airway in mandibular prognathism patients after the combined orthodontic and orthognathic treatment.

METHODSThe sample included 28 skeletal Class III patients (13 males, 15 females) who had undergone mandibular setback surgery and orthodontic treatment. Cone-beam CT was taken one week before treatment (T0), 6 months (T1) and 3 years after surgery (T2). Raw data were reconstructed into three-dimensional model. Sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed.

RESULTSSix months after surgery, oropharyngeal volume [(9 021 ± 4 263) mm³], hypopharyngeal volume [(9 236 ± 5 963) mm³] and total volume [(28 619 ± 9 854) mm³] decreased significantly (P < 0.05). Three years after surgery, only sagittal diameters [(15.9 ± 3.5) mm] and cross sectional areas [(996 ± 398) mm²] in the first cervical vertebra plane came back to the original levels (P > 0.05).

CONCLUSIONSThe pharyngeal airway space decreased after orthodontic-orthognathic therapy in the short term and it increased in some areas in the long term.

Cephalometry ; Cone-Beam Computed Tomography ; Female ; Humans ; Hypopharynx ; anatomy & histology ; diagnostic imaging ; Male ; Malocclusion, Angle Class III ; diagnostic imaging ; surgery ; Oropharynx ; anatomy & histology ; diagnostic imaging ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Pharynx ; anatomy & histology ; diagnostic imaging ; Time Factors