OBJECTIVE: To evaluate the decompensation effectiveness and alveolar bone remodeling of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion using lateral cephalogram and cone-beam computed tomography (CBCT). METHODS: Thirty high-angle patients with skeletal class Ⅱ malocclusion who had received preoperative orthodontic treatment and orthognathic surgery in Peking University School and Hospital of Stomatology between Ja-nuary 2017 and August 2022 and had taken lateral cephalogram and CBCT before and after preoperative orthodontic treatment were selected. Items were measured with lateral cephalogram including: The lower central incisor (L1)-Frankfort plane angle (L1-FH), the L1-mandibular plane angle (L1-MP), the L1-nasion-supramental angle (L1-NB) and the vertical distance from the incisal edge of lower central incisor to NB line (L1-NB distance), etc. The incidence of dehiscence/fenestration and the length of dehiscence at labial side (d-La) and lingual side (d-Li) were measured using CBCT. Pearson correlation analysis was used to evaluate the correlation between the changes of d-Li of L1 and age, duration of preoperative orthodontic treatment and the cephalometric measurements before preoperative orthodontic treatment to screen out risk factors affecting the periodontal risk of preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusions. RESULTS: After preoperative orthodontic treatment, L1-FH, L1-MP, L1-NB and L1-NB distances changed by 11.56°±5.62°, -11.13°±5.53°, -11.57°±5.43° and (-4.99±1.89) mm, respectively, and the differences were all statistically significant (P < 0.05). Among the 180 measured mandibular anterior teeth, 45 cases with labial dehiscence/fenestration before preoperative orthodontic treatment (T0) had no longer labial dehiscence/fenestration after preope-rative orthodontic treatment (T1); 142 cases without lingual dehiscence/fenestration at T0 had lingual dehiscence/fenestration at T1. After preoperative orthodontic treatment, the d-La of lower lateral incisors (L2), lower canines (L3) and lower anterior teeth (L1+L2+L3) decreased by (0.95±2.22) mm, (1.20±3.23) mm and (0.68±2.50) mm, respectively, and the differences were statistically significant (P < 0.05); the d-Li of L1, L2, L3 and L1+L2+L3 increased by (4.43±1.94) mm, (4.53±2.35) mm, (3.19±2.80) mm and (4.05±2.46) mm, respectively, and the differences were statistically significant (P < 0.05). The increase of d-Li of L1 was positively correlated with L1-FH (r=0.373, P=0.042). CONCLUSION This study showed that high-angle patients with skeletal class Ⅱ ma-locclusion could achieve ideal decompensation effect of mandibular anterior teeth after preoperative orthodontic treatment with bilateral mandibular first premolars extracted, but the lingual periodontal risk of mandibular anterior teeth was increased. This risk could be correlated to L1-FH before preoperative orthodontic treatment, which should be paid more attention in the design of orthodontic-orthognathic surgical treatment.
Humans ; Malocclusion, Angle Class III ; Malocclusion, Angle Class II/surgery* ; Facial Bones ; Incisor ; Orthognathic Surgical Procedures ; Cone-Beam Computed Tomography ; Mandible

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

Hypothyroidism is a common endocrine disease with reduced systemic metabolism, but the initial diagnosis is rare in oral and maxillofacial surgery. Due to the nonspecific symptoms, it is easy to be misdiagnosed and missed diagnosis which results in serious consequences. This paper presents a case of severe hypothyroidism which was characterized by airway obstruction, facial swelling, unexplained anaemia and bipedal edema after orthognathic surgery. With review of relevant literatures, this article discusses the risk factors, symptoms, diagnosis and therapy of hypothyroidism.
Edema ; Facial Bones ; Humans ; Hypothyroidism/etiology* ; Orthognathic Surgery ; Orthognathic Surgical Procedures

BACKGROUND: Nasal fracture and orbital blowout fracture often occur concurrently in cases of midface blunt trauma. Generally, these multiple fractures treatment is surgery, and typically, the nasal bone and orbit are operated on separately. However, we have found that utilizing a transconjunctival approach in patients with concurrent nasal bone fracture and orbital blowout fracture is a useful method. METHODS: The participants in the present study included 33 patients who visited the Plastic Surgery outpatient department between March 2014 and March 2017 and underwent surgery for nasal fracture and orbital blowout fracture. We assessed patients’ and doctors’ satisfaction with surgical outcomes after indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture with associated orbital blowout fracture. RESULTS: According to the satisfaction scores, both patients and doctors were satisfied with transconjunctival approach. CONCLUSION: We presented here that our method enables simultaneous operation of nasal fracture accompanied by orbital blowout fracture, rather than treating the two fractures separately, and it allows precise reduction of the nasal fracture by direct visualization of the fracture site without any additional incisions or difficult surgical techniques. Also, by preventing the use of excessive force during reduction, this method can minimize damage to the nasal mucosa, thereby reducing the incidence of nasal bleeding.
Epistaxis ; Facial Bones ; Fractures, Multiple ; Humans ; Incidence ; Methods ; Nasal Bone* ; Nasal Mucosa ; Orbit* ; Orbital Fractures ; Outpatients ; Surgery, Plastic

OBJECTIVEA study was conducted to investigate the relevant applied technique and clinical value of endoscope-assisted repair of zygomatic arch fracture.

METHODSA total of 10 cases of unilateral zygomatic arch fracture and 8 cases ofunilateral zygomatic fracture were included. Reduction and fixation of the zygomatic arch in all cases were performed via asmall face incision by an endoscope. Endoscope-assisted repair allowed exposure of zygomatic arch fracture and ended the anatomy of the reset. Zygomatic arch was stabilized with titanium plates.

RESULTSSymmetric malar was achieved in allcases after operation. Patients did not show difficulty in opening the mouth. No chewing problems or severe complicationswere evident. This method had the advantage of hidden incision, and it did not leave scars on the face. Postoperative CT examination showed excellent reduction of zygomatic arch fracture and good fixed position of titanium plate.

CONCLUSIONEndoscope-assisted repair of zygomatic arch fracture via a small face incision can be an alternative operation for zygomaticarch fracture. Patients are less traumatized. There are fewer complications. A good reduction of fracture is achieved.

Bone Plates ; Endoscopes ; Endoscopy ; methods ; Facial Bones ; Fracture Fixation, Internal ; methods ; Fractures, Closed ; surgery ; Humans ; Titanium ; Tomography, X-Ray Computed ; Treatment Outcome ; Wound Healing ; Zygoma ; injuries ; Zygomatic Fractures ; diagnostic imaging ; surgery

OBJECTIVEThis study aims to evaluate the effect of customized titanium mesh, which was designed by mirror imaging and rapid prototyping technique, with Medpor applied for orbital fracture with enophthalmos.

METHODSOrbital axial, coronal, and sagittal CT scan, and three-dimension CT examination were performed routinely in. 18 cases of orbital fracture with enophthalmos preoperatively. Based on the CT data, prosthesis model was designed by reverse engineering and rapid prototyping technique. The customized titanium mesh and Medpor were applied for orbital reconstruction and enophthalmos correction. Orbital reduction and globe projection were evaluated by postoperative CT scan and clinical follow-up visits.

RESULTSCT scans revealed that the customized titanium mesh with Medpor had great accuracy to reconstruct the orbital fracture and correct the enophthalmos in all patients without serious complications. The eye and facial appearance and function recovered significantly. No serious complication occurred in the operation and after operation.

CONCLUSIONThe customized titanium mesh, based on mirror imaging and rapid prototyping technique, can accurately reconstruct the orbital fractures with enophthalmos. The application of Medpor can effectively correct enophthalmos and eyeball mobility malformation.

Enophthalmos ; therapy ; Facial Bones ; Humans ; Orbit ; Orbital Fractures ; surgery ; Polyethylenes ; Postoperative Period ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Surgical Mesh ; Titanium ; Tomography, X-Ray Computed

OBJECTIVETo investigate the application of three-dimensional CT(3D-CT) in the treatment of oblique facial clefts with mandibular outer cortex, including the surgical design and results assessment.

METHODSFrom Jan. 2003 to Dec. 2013, 22 cases with oblique facial cleft, who underwent mandibular outer cortex onlay bone graft were retrospectively studied. 3D images from CT data were reconstructed before operation for design. Then the mandibular outer cortex onlay bone transplant was performed to reconstruct the bone defect and cleft. 3D CT was performed 5-10 days postoperatively and 6- 12 months postoperatively to assess the facial symmetry.

RESULTSAccording to the results of CT measurement, the average volume of the orbital bone defects on the affected side decreased by(64. 6 ± 14. 4)% 5 to 10 days after operation. The average volume of the maxillary and zygomatic bone defects on the affected side decreased by(71.4 ± 15.7)% after surgery. After 6 to 12 months,the average recovery of the mandibular donor site was (57. 9 ± 13. 9)% of the removed mandibular outer cortex. The average absorption of grafted bones was(24.7 ± 25.6 )%. The average height difference between the centre of pupils on both sides before surgery was(3.76 ± 1.27) mm,which decreased to( 1. 15 ± 1.00) mm 5 to 10 days after surgery(P =0. 000) , and( 1.35 ± 1. 13) mm 6 to 12 months after surgery(P = 0. 003). The relapse may be caused by the absorption of the grafted bones.

CONCLUSIONS3D-CT can be used for preoperative design and postoperative assessment in the treatment of oblique facial cleft with mandibular outer cortex.

Bone Transplantation ; Cleft Palate ; surgery ; Craniofacial Dysostosis ; surgery ; Eye Abnormalities ; surgery ; Facial Bones ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Mandible ; transplantation ; Maxillofacial Abnormalities ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Transplant Donor Site

BACKGROUND: If patients have a better understanding about their problem and treatment, compliance and satisfaction with treatment will increase. For this purpose, simple repeated explanations regarding a patients' problem and treatment are essential. Critical pathway (CP) has a very wide range in medicine with the exception of the plastic surgery field. The authors developed a CP for facial bone fractures and implemented it clinically. The aim of this study was to evaluate the effectiveness of the CP on the degree of recognition of the problem along with patient satisfaction with the treatment process. METHODS: From May 2011 to October 2011, a total of 82 patients suffering from facial bone fractures were studied. The CP for facial bone fractures was developed by plastic surgeons, residents and nurses. Subsequently, the authors investigated the degree of recognition of the disease and patient satisfaction with the treatment through the use of a questionnaire. The authors compared the score of the questionnaires before and after implementation of the clinical pathway. RESULTS: The degree of the recognition of the problem changed from 3.1 to 4.2 (p<0.001). Further, the degree of satisfaction with the treatment process changed from 3.6 to 4.3 (p<0.05). Overall, there was a two point increase in improvement. CONCLUSION: Implementation of the CP for facial bone fractures was effective in improving the degree of recognition and satisfaction. The authors expect that hereafter, the CP for facial bone fractures will be implemented actively in the plastic surgery field.
Compliance ; Critical Pathways* ; Facial Bones* ; Humans ; Patient Satisfaction ; Surgery, Plastic ; Surveys and Questionnaires

OBJECTIVE: By summary and analysis of rigid internal fixation for the treatment of maxillofacial fractures incision and exposure, investigate the plate reasonable surgical approach of fracture reduction and fixation titanium. METHOD: Summary of the 76 surgical cases, Counting the statistics of the number that the surgery ways choose by facial incision and fractures location, analysis of the indications for surgery and the advantages and disadvantages of various surgical approaches. Followed up for more than six months, in order to observe the recovery of occlusal function and the facial cosmetic results. RESULT: The upper jaw or cheek bone has the more possibility in facial fracture, which used of a small incision hidden under the lip gingival sulcus and lower eyelid. After six months, the facial wound healing recover in good occlusal with no obvious scarring. CONCLUSION Reasonable choice of surgical incision can make the fracture site exposure and the facial aesthetic effect into account.
Adult ; Bone Plates ; Facial Bones ; injuries ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Retrospective Studies ; Titanium

PURPOSE: Nasotracheal or oral intubation procedure is widely used for facial bone fractures. However, during the operation intubated tube can interfere or obstruct the view of the operator. We authors used a modified submental intubation method in panfacial bone fracture patients for intact airway and the operation view. METHODS: After intravenous induction of anaesthesia, traditional orotracheal tubation was done. A horizontal incision was made 2cm from the midline, 2cm medial to and parallel with the mandible in the submental region.1 In order to approach to the floor of the oral cavity, a haemostat was pushed through the soft tissues. A chest tube front cover was applied to the intubation tube and the tube was inserted through the submental tunnel. Orotracheal tube was disconnected and pulled back through the soft tissue and secured with a suture. RESULTS: The procedure took about 30 minutes and there were no problems during the intubation. Intraoral manipulation and occlusal checks were free without any interference. Extubation was also easily done without any complications such as lung aspiration, infection, hematoma, or fistula. CONCLUSION: Submental endotracheal intubation is fast, safe, easy to use and free from the concern about the tube being pull back again. Conventional submental intubations are being held without any coverage of the tip. We authors applied the modified method to the trauma patients and obtained satisfactory results. From the above advantages, modified submental intubation can be widely available not only in fractured patients, but also in aesthetic or orthognathic surgeries.
Chest Tubes ; Facial Bones ; Floors and Floorcoverings ; Fractures, Bone ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal ; Lung ; Mandible ; Mouth ; Orthognathic Surgery