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Purpose: In planning intraoral quadrangular Le Fort II osteotomy (IQLFIIO), simulation of hard and soft tissue changes will be important at the infraorbital, Le Fort I, and incisor level. The aim of our study was to evaluate a new method for visualization and quantification., Materials and Methods: Three different methods of quantification were compared: the point-to-point (PTP) measurement, which has been viewed as the reference standard; part comparison analysis (PCA); and a new method, the midfacial advancement line (MFAL) measurement. We performed a measurement comparison study using the Bland-Altman method to measure agreement and enrolled patients with midfacial deficiency and Class III malocclusion who had undergone IQLFIIO. The primary predictor variable was the method of measurement. The primary outcome variable was the amount of midfacial advancement. We also investigated the time required, visualization quality, and interobserver agreement., Results: The sample included 12 subjects with a mean age of 21.6 years; 7 patients were male. The PTP and MFAL showed no significant observer dependence. The advancement measured with PTP and MFAL showed no significant differences. However, the advancement measured using MFAL and PCA showed a significant difference. The highest rating of visualization was found for MFAL. The time requirements were similar for all 3 methods., Conclusions: Our results have shown that the MFAL is a suitable method for visualization and quantification of soft and hard tissue changes at all 3 face levels in 1 image. It could be a valuable tool for virtual planning of midfacial advancement surgery., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate soft tissue changes after intraoral quadrangular Le Fort II osteotomy (IOQLFII) and correlate those changes to underlying osseous changes., Materials and Methods: Twenty-six non-growing patients with midfacial deficiency and Class III malocclusion were analyzed. A study group of 13 patients who underwent IOQLFII was compared with 13 patients who underwent conventional Le Fort I osteotomy (LFI). After fusion of pre- and postoperative computed tomograms, each patient's hard and corresponding soft tissue changes were measured. Measurement points were defined at 3 levels in the IOQLFII group (infraorbital rim [IR], sinus floor [SF], and lateral incisor tip [LI]) and at 2 levels in the LFI group (SF and LI). Linear models were created to test for correlations between hard and soft tissues., Results: The slope (a 1 coefficient) between anteroposterior hard and soft tissue changes was found to be highly significant at each measurement point for all groups. In the IOQLFII group, soft tissue advancement was 69% (confidence interval [CI], 62 to 77%) of the hard tissue advancement at the IR, 90% (CI, 84 to 96%) at the SF, and 73% (CI, 64 to 82%) at the LI. In the LFI group, the corresponding percentages were 90% (83 to 97%) at SF and 84% (77 to 90%) at LI., Conclusion: IOQLFII results in predictable correction of midfacial deficiency. At the IR, bony advancement always resulted in markedly less soft tissue advancement than at the SF level. These results indicate that the planned infraorbital advancement should not be too conservative because soft tissue changes are smaller in this region., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Impacted, in particular transmigrated, lower canines are rare. If they transmigrate, then the most common treatment is extraction. Alternatively, the native tooth can be preserved; however, management is complex. This report describes a decision-making flowchart (DMFC) with surgical strategies for the management of impacted lower canines., Materials and Methods: Fifty-six patients had impacted lower canines, of which 16 were transmigrated. A preliminary version of the DMFC was used for the development of treatment plans to decide which strategy to apply to these complex cases. After removal of associated pathologies (for experimental tooth-preserving therapies), miniscrews were used as transient skeletal anchorage devices (TADs). The TADs allowed a closed surgical approach for impacted and transmigrated lower canine eruption. For autotransplantation, a dummy tooth was used for socket preparation to minimize the period of no blood supply to the graft., Results: After surgical exposure and TAD insertion, orthodontic treatment was performed in 4 patients. One patient was selected for successful autotransplantation. Nine patients had the transmigrated canines surgically removed. The remaining patients opted for "leave and observe." Based on the satisfactory long-term results with orthodontic treatment and autotransplantation and on published reports, the resulting DMFC presents key aspects of the treatment plan, namely 1) associated pathology, 2) patient age, 3) compliance, and 4) root tip position., Conclusions: TAD-assisted orthodontic treatment and autotransplantation of impacted lower canines are tooth-preserving alternatives to extraction. The developed DMFC assists the complex treatment planning of impacted and transmigrated lower canines., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Reconstruction of orbital deformities is a challenging task. Virtual 3-dimensional (3D) planning and the use of patient-specific implants (PSIs) could improve anatomic and functional outcomes in the orbital region., Materials and Methods: A retrospective study was performed of patients who underwent late orbital reconstruction from 2009 to 2013. To be included in the study, patients had a unilateral orbital deformity by involvement of at least 2 orbital wall defects. No orbital osteotomies could be used to correct the deformity. All patients underwent 3D virtual treatment planning. The unaffected orbit was mirrored onto the affected orbit. The PSI was fabricated according to this plan. Navigation was used to check the implant position., Results: Six patients were included in this study. All patients had diplopia or motility limitations and enophthalmos. The ophthalmic parameters showed improvement in all patients. Enophthalmos was corrected adequately by the PSI. Four patients received a poly-ether-ether-ketone PSI. Two patients received a titanium mesh PSI. The position of the PSI was controlled by intraoperative navigation. Superimposition of the planned and postoperative positions of the PSI showed good correlation., Conclusion: PSIs placed with intraoperative navigation facilitate late or secondary correction of orbital deformities., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To perform a systematic review of the published data concerning maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome., Materials and Methods: A systematic literature search was performed in the PubMed database. Original articles in the English language were reviewed to obtain information about patient data, success rates, and outcome measures., Results: The systematic literature search yielded 1,113 citations, of which 101 articles met our inclusion criteria. After a review of the full text, 39 studies were included in the analysis. Most articles were classified as evidence level 4, and 5 met the inclusion criteria for level 2b. The only prospective randomized controlled study had been published in January 2010 and was assigned level 1b., Conclusions: A recommendation grade of A to B was achieved with regard to the levels of evidence-based medicine. Our results have shown that maxillomandibular advancement is the most successful surgical therapy, and the postoperative polysomnography results are comparable to those under ventilation therapy., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)