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Objectives: Successful orthognathic surgery requires accurate transfer of the intraoperative surgical plan. This study aimed to (1) evaluate the surgical error of a novel intermediate splint in positioning the maxilla during maxilla-first orthognathic surgery and (2) determine factors influencing surgical error., Materials and Methods: This prospective study examined 83 patients who consecutively underwent Le Fort I osteotomy for correction of skeletal class III deformity using a novel intermediate splint and a bilateral sagittal split osteotomy. Surgical error was the outcome variable, measured as the difference in postoperative translational and rotational maxillary position from the virtual plan. Measures included asymmetry, need and amount for mandibular opening during fabrication of intermediate splints, and planned and achieved skeletal movement., Results: Mean errors in translation for vertical, sagittal, and transversal dimensions were 1.0 ± 0.7 mm, 1.0 ± 0.6 mm, and 0.7 ± 0.6 mm, respectively; degrees in rotation for yaw, roll, and pitch were 0.8 ± 0.6, 0.6 ± 0.4, and 1.6 ± 1.1, respectively. The transverse error was smaller than sagittal and vertical errors; error for pitch was larger than roll and yaw (both p < 0.001). Error for sagittal, transverse, and roll positioning was affected by the achieved skeletal movement (roll, p < 0.05; pitch and yaw, p < 0.001). Surgical error of pitch positioning was affected by planned and achieved skeletal movement (both p < 0.001)., Conclusions: Using the novel intermediate splint when performing Le Fort I osteotomy allowed for accurate positioning of the maxilla., Clinical Relevance: The novel intermediate splint for maxillary positioning can be reliably used in clinical routines., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Two-jaw orthognathic surgery (OGS) is done using either the one-splint technique with free-hand positioning of the maxillomandibular complex or the two-splint technique with intermediate splints to position the maxilla. It is uncertain which technique achieves better outcomes. This study compares frontal soft tissue symmetry and subjective patient QoL between one-splint and two-splint techniques in skeletal Class III asymmetry patients undergoing OGS with three-dimensional surgical planning., Materials and Methods: This retrospective case-control study comprised 34 one-splint and 46 two-splint OGS patients. Frontal photographs and Orthognathic Quality of Life Questionnaire (OQLQ) were done pre- and post-treatment. Frontal soft tissue symmetry was analysed with the anthropometric Facial Symmetry Index. Measurements were compared with t-tests and chi-squared tests with p-value set at 0.05., Results: The groups differed in pre-treatment ANB and OQLQ scores. The two-splint group showed significant improvement in all symmetry measures. The one-splint group showed significant improvement in all symmetry measures except midface deviation, upper contour deviation and the Facial Contour Symmetry Index. Both groups showed significant improvement in OQLQ scores. There were no significant differences in post-treatment symmetry measurements and OQLQ scores between groups., Conclusions: Although two-splint technique may better improve contour symmetry, there were no significant differences in frontal soft tissue symmetry and QoL after OGS in skeletal Class III asymmetry with either one-splint or two-splint technique, with both techniques resulting in significant improvement., Clinical Relevance: One-splint and two-splint surgical techniques produce similar patient-centred outcomes in Class III asymmetry patients., (© 2021. The Author(s).)

Background: The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting., Method: This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze., Results: There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained., Conclusions: Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Background: Modern orthognathic surgery (OGS) was established on the basis of contributions from multidisciplinary centers worldwide. This study reports the history and evolution of OGS at the Chang Gung Craniofacial Center (CGCC) and identifies the lessons learned from 35 years of experience., Methods: The total number of OGS procedures managed by the CGCC multidisciplinary team between 1981 and 2016 was determined. The database of the senior author (Y.-R.C.) was reviewed for consecutive OGS procedures performed between 2003 and 2016. A literature review was also performed to retrieve the contributions from the total CGCC team., Results: The 35 years of experience at a single center and 13-year experience of a single surgeon corresponded to 8073 and 2883 OGS procedures, respectively. Moreover, 53 peer-reviewed articles were reviewed. Teamwork (plastic surgeons, orthodontists, and anesthetists) ensured an optimal balance between occlusion functional and facial aesthetic outcomes, with patient safety ensured and a minimum of OGS-related complications. Progression from the conventional orthodontics-first approach to the surgery-first OGS approach decreased the overall treatment time. Transition from 1-jaw to 2-jaw surgery enabled more consistent aesthetic outcomes to be achieved. Conversion from the 2-splint to the single-splint technique enabled development of a more precise tridimensional simulation plan and surgical execution, including in challenging scenarios such as malocclusion associated with facial asymmetry. Clockwise pitch rotation of the maxillomandibular complex has been designed for facial aesthetic purposes in class III malocclusion, whereas counterclockwise pitch rotation of the maxillomandibular complex improves airway function in those with sleep apnea., Conclusions: The lessons learned from experience and outcome-based articles reveal that OGS has successfully evolved at the CGCC, with a balance being achieved between functional and aesthetic outcomes and effective decreases in the burden of care (ie, morbidity, complications, and treatment time).

Objectives: To compare the facial asymmetry after bimaxillary surgery between mild craniofacial microsomia (CFM) and non-syndromic class II asymmetry. Materials and methods: Cone-beam computed tomography scans of adults with Pruzansky-Kaban types I and IIA CFM (CFM groups, n = 20), non-syndromic skeletal class II asymmetry (Class II group, n = 20), and normal controls (control group, n = 20) were compared. The area asymmetry of lower face and jaw bones was quantified. Landmark-based method was used to evaluate the lower facial asymmetry regarding midline, cants, and contour. Results: There were no significant postoperative differences in the hemi-facial and hemi-jaw area asymmetry between CFM and Class II groups, both of which were significantly larger than the control group. No significant difference was found in the midline deviation and lip and occlusal cants between CFM and Class II groups. The vertical contour asymmetry in CFM group became significantly larger than Class II group. Compared to the control group, the deviation of pronasale, subnasale, and soft-tissue menton, lip and occlusal cants, and sagittal and vertical contour asymmetry in CFM group were significantly larger, as were the deviation of subnasale and soft-tissue menton and vertical contour asymmetry in Class II group. Conclusions: The vertical contour asymmetry of mild CFM was significantly larger than non-CFM class II after surgery, while the area asymmetry, midline deviation, cants, and sagittal contour asymmetry of lower face showed no significant difference. Clinical relevance: Be aware that correcting vertical asymmetry of contour, lip, and dentition in CFM is still challenging. [ABSTRACT FROM AUTHOR]

Skeletal stability after orthognathic surgery is essential for positive treatment outcome. This study evaluated the stability of osteotomy segments after surgery-first bimaxillary surgery for class III asymmetry. Seventy adults with class III asymmetry consecutively corrected through surgery-first Le Fort I and bilateral sagittal split osteotomies were investigated. Cone-beam computed tomography before treatment (T0), 1-week after surgery (T1), and after all treatment (T2, ≥1-year after surgery) was used to assess surgical movement (T0 to T1) and skeletal stability (T1 to T2) regarding the translation and rotation of the maxillary, mandibular distal, and proximal segments. At T1, the maxillary segment had moved forward and upward, turned to the deviated side, and rotated downward (all P < 0.01). The distal segment of mandible had moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment had moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment had moved upward and tilted to the deviated side (both P < 0.01). At T2, significant relapse occurred in the mandible. The distal segment moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment moved upward and tilted to the deviated side (both P < 0.01). Clinically significant relapse of class III asymmetry was discovered on the mandibular distal and opposite proximal segments. [ABSTRACT FROM AUTHOR]

Objectives: Some adults with cleft lip and palate (CLP) require orthognathic surgery due to skeletal deformity. This prospective study aimed to (1) compare skeletal stability following bimaxillary surgery for correction of class III deformity between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (2) identify risk factors of stability. Materials and methods: Adults with CLP and skeletal class III deformities who underwent surgery-first bimaxillary surgery were divided into two groups according to cleft type: UCLP (n = 30) and BCLP (n = 30). Skeletal stability was assessed with measures from cone beam computed tomography images of the maxilla and mandible taken before treatment, 1-week and ≥ 1 year postsurgery for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch); multiple regression analysis examined risk factors. Results: At follow-up, the maxilla moved upwards in both groups, and backwards in the UCLP group. The mandible moved forward and upward, shifted to the cleft (deviated) side, and rotated upward in both groups. The amount of surgical advancement was a risk factor for sagittal stability in the maxilla (ß = −0.14, p < 0.05). The mandible had three risk factors for sagittal stability: age (ß = −0.23, p < 0.05), surgical team (ß = −1.83, p < 0.05), and amount of surgical setback (ß = −0.32, p = 0.001). Conclusions: Two years after bimaxillary surgery, patients with UCLP had a higher sagittal relapse of the maxilla compared with patients with BCLP, which was due to a greater surgical advancement in the patients with UCLP. Clinical relevance: Surgery-first bimaxillary surgery results in favorable treatment outcomes for correction of cleft-related class III deformity. Severity of jaw discrepancy and surgeons should be considered in the surgical design of overcorrection. [ABSTRACT FROM AUTHOR]

Objectives: Patients with cleft lip–cleft palate (CLP) often require orthodontic treatment, with or without orthognathic surgery. Patient satisfaction is the most important outcome parameter in orthodontic treatment. This study aimed to (1) determine patient satisfaction and quality of life (QoL) after orthodontic treatment and (2) identify associated factors. Material and methods: This prospective cross-sectional study recruited patients with CLP who had completed orthodontic treatment at a craniofacial center in Taiwan. Participants (N=213) had received treatment for unilateral CLP (n=99), bilateral CLP (n=50), cleft lip and alveolus (n=39), and isolated cleft palate (n=25). Self-report questionnaires evaluated satisfaction with appearance and QoL; multiple regression analysis examined associated factors. Participants' expectations of treatment results were also reported. Results: Participants reported moderate satisfaction with facial appearance and QoL. Satisfaction with treatment was lower or much lower than expected for 13% of participants. Treatment for bilateral CLP was associated with the lowest satisfaction with overall appearance (r = −8.123, P < 0.05); participants who had received orthognathic surgery had the highest satisfaction (r = 5.534, P < 0.05). Treatment for unilateral and bilateral CLP was associated with low QoL for smile (both P < 0.05). Conclusions: Orthodontic treatment had a positive effect on facial appearance and quality of life in patients with CLP. Type of cleft and orthognathic surgery significantly influenced satisfaction with facial appearance. Clinical relevance: Efforts must be taken to modify treatment strategies for patients with bilateral CLP in order to improve satisfaction with appearance following treatment. [ABSTRACT FROM AUTHOR]

Objectives: Postsurgical skeletal relapse is a concern for class II deformities corrected with counterclockwise rotation of the occlusal plane. Therefore, the aim of this study was to compare the skeletal stability between large and small counterclockwise rotational advancement of the mandible in patients with skeletal class II deformity. Materials and methods: This retrospective study included 50 adult patients with skeletal class II deformity corrected by Le Fort I setback and bilateral sagittal split osteotomy counterclockwise rotational advancement. Patients were divided into two groups, according to the amount of counterclockwise rotation: small rotation (n = 25) and large rotation (n = 25). Serial cone beam computed tomography scans were analyzed to identify skeletal and dental position from presurgery to at least 12 months postsurgery. Changes in the facial skeleton (maxilla and mandible) and teeth (central incisor and first molar) were determined for six skeletal and four dental landmarks by measures before treatment (T0) and 1 week postsurgery (T1), and from T1 to at least 12 months postsurgery (T2). Results: A relapse was found both after large and small rotational advancement of the mandible (pogonion: 1.0 (2.4) mm and 1.4 (3.0) mm, respectively). The result was statistically significant (both p < 0.05) and was with less than 1.5 mm clinically acceptable. There were no between-group differences in the postsurgical horizontal and vertical mandibular stability. Conclusions: The results suggest that counterclockwise rotational advancement of the mandible using bilateral sagittal split osteotomy is a clinically stable procedure. The amount of rotation does not affect the postsurgical stability of the mandible. Clinical relevance: The findings help clinicians better understand the surgical and postsurgical changes of the skeleton and teeth after counterclockwise rotational advancement of the mandible for class II deformity. [ABSTRACT FROM AUTHOR]

Objectives: To determine if patient outcome variables differ between conventional and virtual surgical planning of orthognathic surgery for class III asymmetry. Material and methods: This retrospective case-control study examined 95 patients with class III asymmetry who had been consecutively treated with at least a Le Fort I osteotomy and a bilateral sagittal split osteotomy with a surgery-first approach. Two groups were examined: 51 patients treated with conventional surgical planning and 44 with virtual surgical planning. After treatment, quantitative assessment was determined with measurements of midline symmetry, contour symmetry, and overall facial symmetry using standardized frontal photographs. Subject assessments were analyzed with questionnaires regarding self-perception of overall appearance, satisfaction with appearance, and quality of life. Results: Conventional and virtual surgical planning resulted in significant improvements in outcomes for all patients. However, facial midline and overall facial symmetry were significantly greater for the virtual compared with the conventional group. There were no significant differences in subjective measures of appearance, satisfaction with appearance, and quality of life for patients treated with conventional or virtual surgical planning; measures were high for both groups. Conclusions: Conventional and virtual surgical planning of surgery-first bimaxillary orthognathic surgery resulted in quantitative and qualitative improvements in facial symmetry. Although patient satisfaction was similar for both approaches, virtual surgical planning was superior to conventional surgical planning for the improvement of midline and overall asymmetry. Clinical relevance: Improvements with virtual surgical planning in facial midline, facial contour, and overall facial symmetry are as good as or better than conventional surgical planning. [ABSTRACT FROM AUTHOR]

The study aimed to evaluate the treatment outcome of bimaxillary surgery for class II asymmetry and find the influencing factors for residual asymmetry. Cone-beam computed tomographic images of 30 adults who had bimaxillary surgery were acquired, and midline and contour landmarks of soft tissue and teeth were identified to assess treatment changes and outcome of facial asymmetry. The postoperative positional asymmetry of each osteotomy segment was also measured. After surgery, the facial midline asymmetry of the mandible, chin, and lower incisors improved significantly (all p < 0.01). However, the residual chin deviation remained as high as 2.64 ± 1.80 mm, and the influencing factors were residual shift asymmetry of the mandible (p < 0.001), chin (p < 0.001), and ramus (p = 0.001). The facial contour asymmetry was not significantly improved after surgery, and the influencing factors were the initial contour asymmetry (p < 0.001), and the residual ramus roll (p < 0.001) or yaw (p < 0.01) asymmetry. The results showed that bimaxillary surgery significantly improved midline but not contour symmetry. The postoperative midline and contour asymmetry was mainly affected by the residual shift and rotational jaw asymmetry respectively. [ABSTRACT FROM AUTHOR]