It is important to be able to diagnose and treat temporomandibular joint (TMJ) pathology as an orthog‐nathic surgeon. The TMJs form the foundation for any orthognathic procedure and it is important ...that they are stable and healthy in order to ensure satisfactory orthognathic outcome. TMJ reconstructive surgery has a long history, beginning in the middle of the 19th century with the use of alloplastic grafts and progressing toward autogenous grafts in the early 20th century. Metatarsal bone was used for the first condylar reconstruction in 1909. Then in 1920, the first costochon‐dral graft was used. Alloplastic materials allow closer reproduction of the normal anatomy of the joint, avoidance of donor site morbidity, reduced surgery time and immediate function and physiotherapy. Conventional surgical planning has involved rapid prototyping, which is used to fabricate stereolitho‐graphic models from computerized tomographic (CT) scans. Imaging of the facial bones is carried out with a high‐resolution contrast‐enhanced CT scan.
Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally ...invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n=44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n=4), endoscopically assisted orthognathic procedures (n=17), or the use of a piezoelectric device in orthognathic surgery (n=25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.
Systematic mapping review of orthognathic surgery Bendersky, Josefina; Uribe, Macarena; Bravo, Maximiliano ...
Journal of stomatology, oral and maxillofacial surgery,
10/2022, Letnik:
123, Številka:
5
Journal Article
Recenzirano
Systematic mapping review
The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding ...co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes.
Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened.
Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence.
Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.
To perform a systematic review to answer the clinical question “What are the longitudinal skeletal and airway changes after mandibular setback orthognathic procedures?”
A systematic search including ...computer search of different databases with specific keywords, manual search through three international journals and reference list search was performed. Articles that were reporting the skeletal and airway changes after mandibular setback orthognathic procedures were evaluated with five predetermined criteria.
Six articles with a total of 217 patients entered the final review. All were rated to be of moderate bias risk. Four studies evaluated the skeletal and airway changes using two-dimensional (lateral) cephalometric radiographic imaging, whereas the other two studies used three-dimensional imaging with cone-beam computed tomography. In the two-dimensional studies, skeletal relapses from T0 (immediate postoperative) to T1 (postoperative 1–6 months) ranged from −2.14 mm to 0.30 mm, whereas skeletal relapses from T1 to T2 (postoperative 1 year) ranged from −0.90 mm to 1.23 mm. In the three-dimensional studies, skeletal relapse from T1 to T2 ranged from −0.26 mm to 1.53 mm. All included studies reported that there were no significant skeletal relapses after mandibular setback procedures. Regarding airway changes, airway changes from preoperative to T0/T1 ranged from −0.30 mm to −2.32 mm in the two-dimensional studies. Airway changes from T0 to T1 ranged from −0.70 mm to −1.63 mm, whereas airway changes from T1 to T2 ranged from 0.11 mm to 0.60 mm, respectively.
This systematic review showed there was insignificant skeletal relapse after mandibular setback orthognathic procedures. It was noted a small increase of the airway over the first post-operative year in studies using 2-dimensional radiography. However, such finding was not consistent in studies using 3-dimensional imaging with volumetric analysis of the airway changes.
The delineation of excessive gingival display and review of current treatment options. Discussion over periodontal and prosthetic treatments, mucosal stripping procedures, myotomies, Botox therapy, ...and orthognathic procedures for correction of the "gummy smile."
For both inpatient and outpatient orthognathic and rhinoplasty procedures, detailed postoperative care instructions may depend on the specifics of the case. However, there are some generalities and ...consistencies in the postoperative management regimen. During the preoperative appointment, we counsel patients and families regarding the preoperative checklist, surgical time, and hospital stay. In every case, close follow‐up outpatient assessment, especially in relation to feeding, respiratory status, and pain management is implemented. Setting postoperative expectations preoperatively is critical, and the authors provide printed instructions and educational materials well in advance of the operation(s). Orthognathic and rhinoplasty patients both must follow specific postoperative care instructions in order to achieve optimal healing. Patients require adequate counseling in the preoperative visit to ensure complete understanding of what they should expect postoperatively. Providing patients with appropriate checklists and handouts will help decrease the likelihood of improper postoperative care and unexpected complications.
This chapter describes endoscopic (minimally invasive surgery) orthognathic procedures, principles of orthodontic tooth preparation for endoscopic orthognathic surgery, and future directions of ...endoscopic surgery. For orthognathic surgery, endoscopy has been included in mandibular procedures, but few in the maxilla. An advantage of endoscopy, in the review of endoscopic techniques in oral and maxillofacial surgery, is its use as an aid in teaching the procedure, posterior anatomy, and avoiding complications for trainees. Unlike the limited use of endoscopy for maxillary procedures, its use in the mandible has been more extensive, including its use in open reduction and internal fixation of mandibular fractures as well as in mandibular orthognathic surgical procedures. Presurgical mandibular leveling depends on the desired final face height. Setting the maxillary and mandibular incisors in an ideal overjet and overbite relationship can create a tripod occlusion and increase the vertical face height.
Surgeons who perform orthognathic procedures need to be familiar with a common and usually severe body image disorder known as body dysmorphic disorder (BDD). Surgeons should directly ask about the ...patient's history of psychiatric and psychological treatment, including psychiatric hospitalization. Cosmetic surgical procedures and dermatologic treatments are most often sought and received by persons with BDD. A screening interview during the initial consultation can be an effective way of identifying patients with BDD. This interview can help safeguard providers against patients who could become litigious or violent; it also provides an opportunity to direct patients with BDD to more effective and appropriate psychiatric treatment. This interview should include an assessment of appearance concerns and BDD symptoms; patient motivations and expectations for the desired procedure; psychiatric status and history; and observations of the patient's behaviour in the office.
Soft Tissue Resuspension Cobb, Alistair R.M; Britto, Jonathan A
Orthognathic Surgery,
2017, 2016-12-16
Book Chapter
The resuspension of the craniofacial soft tissue envelope may be used to help reduce the ptosis of the soft tissues that may result following the subperiosteal surgical degloving used to access the ...facial skeleton. Facial shape and volume can also be modified by surgical adjustment of the position and depth of soft tissue fixation, and the extent of midface degloving from the maxilla. The technique is useful in the closing stages of midface and craniofacial surgery, after skeletal fixation has been achieved (when required) and the soft tissue envelope has been liberated subperiosteally. Surgical degloving of the tissues in the subperiosteal plane to access the facial bones liberates the tissues, which will descend down the facial skeleton unless resuspended. Following orthognathic procedures at the le Fort I level to improve the midfacial projection, one may now consider repositioning the midfacial soft tissues in a supero‐lateral vector, akin to a midface lift.
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