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

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.
Adult ; Facial Asymmetry ; complications ; diagnostic imaging ; surgery ; Genioplasty ; Humans ; Imaging, Three-Dimensional ; Jaw Abnormalities ; complications ; diagnostic imaging ; surgery ; Male ; Mandible ; abnormalities ; diagnostic imaging ; surgery ; Occlusal Splints ; Oral Surgical Procedures ; methods ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Patient Care Planning ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed

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 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 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

OBJECTIVETo analysis the maxillary bony structures by three-dimensional CT in maxillary retrognathism patients so as to provide information for Le Fort I osteotomy.

METHODS20 maxillary retrognathism patients underwent Le Fort I osteotomy, while 20 patients with simple mandibular fractures were included as control group. All the patients received Skull 3-D CT before operation. The measurement about descending palatine artery and wing palatal was performed by Surgicase 5.0. The data were analyzed statistically.

RESULTSThe average distance from the piriform aperture margin to wing palatal tube was (33.74 +/- 6.74) mm in the retrognathism group; while (35.67 +/- 7.50) mm in the control group, showing a significant difference between the two groups (P < 0.05), but there was no statistically difference in the height of pterygomaxillary junction between the two groups.

CONCLUSIONThe safe depth for Le Fort I osteotomy in patients with hypoplasia maxilla is 32 mm. CT scanning can provide guidance for osteotomy.

Adolescent ; Arteries ; Humans ; Maxilla ; surgery ; Osteotomy, Le Fort ; methods ; Palate ; blood supply ; Radiography, Interventional ; methods ; Retrognathia ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo sum up the various procedures for skeleton and soft tissue contour reconstruction in severe progressive hemifacial atrophy.

METHODSFrom Jan 2004 to May 2012, 25 patients with severe progressive hemifacial atrophy underwent the procedures of lipoinjection, microsurgical flap transplantation, dermis grafting, distraction osteogenesis, orthognathic surgery and so on for both skeleton and soft tissue reconstruction.

RESULTSAmong them, zygomatic augmentation and lipoinjection were performed in 24 cases, anterolateral thigh adipofascial flap in 10 cases and latissimus dorsi flap in one case, orthognathic surgery in 17 cases, including Le Fort I osetoectomy in 3 cases, genioplasty in 4 cases, mandibular distraction osteogenesis combined with secondary Le Fort I osteotomy in 3 cases, genioplasty combined with mandibular augmentation with Medpor implant in 7 cases. The patients were followed up for 6 months to 5 years. Through skelton and soft tissue reconstruction, the oblique occlusion plane and malocclusion were corrected with great improvement in face asymmetry.

CONCLUSIONSFor severe progreassive hemifacial atrophy, comprehensive procedures should be adopted for both skelton and soft tissue reconstruction to achieve good results.

Adipose Tissue ; transplantation ; Facial Asymmetry ; surgery ; Facial Hemiatrophy ; surgery ; Humans ; Mandible ; surgery ; Orthognathic Surgical Procedures ; Osteogenesis, Distraction ; methods ; Osteotomy, Le Fort ; methods ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; transplantation

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

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 three-dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate (CLP).

METHODSThree-dimensional FEM models of Le Fort I, II and III osteotomy in CLP patients were established. External midface distraction were simulated. An anteriorly and inferiorly directed 900 g force was applied to bilateral maxillary arch in directions 30 degrees to the occlusal plane. Biomechanical changes for the maxillary complex were investigated by means of finite element analysis.

RESULTSMaxillary complex was advanced after different osteotomy. Constriction of alveolar crest and palate occurred in Le Fort I osteotomy, but not in Le Fort II and III osteotomy. Clockwise rotation occurred in Le Fort I osteotomy complex. Counterclockwise rotation occurred in Le Fort II and III osteotomy complex.

CONCLUSIONSThree-dimensional finite element research on external midface distraction could provide reference for the preoperative design.

Cleft Lip ; surgery ; Cleft Palate ; surgery ; Female ; Finite Element Analysis ; Humans ; Maxilla ; surgery ; Osteogenesis, Distraction ; methods ; Osteotomy, Le Fort ; methods ; Young Adult