orthognathic surgery

Cephalometric analysis is essential for assessing facial proportions and planning treatments in orthodontics. Different populations, like the Kurdish group, have unique facial features, requiring specific norms for accurate clinical practice. This study establishes these norms for the Kurdish population.

A cross-sectional study was conducted on 111 lateral cephalometric radiographs of Kurdish individuals aged 20-45 with balanced facial characteristics and class I occlusion. Radiographs were traced using digital tracing methods to measure total anterior facial height (TAFH), upper anterior facial height (UAFH), and lower anterior facial height (LAFH). The UAFH/TAFH and LAFH/TAFH ratios were also calculated. Statistical analysis was performed using SPSS version 29.

The study establishes cephalometric norms for the Kurdish population, highlighting significant sex differences in facial height measurements. These findings contribute to a more nuanced understanding of facial morphology in the Kurdish population, with implications for improving orthodontic and orthognathic treatment outcomes.

The study provides cephalometric norms for the Kurdish population, aiding in personalized orthodontic and orthognathic treatment planning. It also highlights significant sex differences, essential for achieving culturally appropriate aesthetic outcomes.

This case report is about a 30-year-old Iranian female. The patient’s chief complaint was the backwardness of the lower jaw. The patient reported a history of condylar fractures in childhood. There was crowding in the maxillary and mandibular arch, and the midline in the mandible was 2 mm deviated to the left. The canine and first premolar on the left side of the maxilla were extracted, and the canine on the left side of the mandible was impacted. Clinical examinations and paraclinical documents revealed that the patient was a skeletal class II case with mandibular deficiency, complicated by a vertical maxillary excess. Virtual surgery planning was used to plan the patient’s treatment. The amount of adhesion of soft tissue to hard tissue was also taken into consideration. According to the measurements of the patient and the class II, vertical maxillary excess of the patient, the shortness of the ramus, and the large angle of the occlusal plane, our chosen orthognathic surgery included bilateral sagittal split osteotomy, advancement genioplasty, and maxillary impaction.

Orthognathic surgery, a pivotal treatment for patients with significant facial aesthetic and occlusal concerns, traditionally involves a phased approach comprising preoperative orthodontics, surgery, and postoperative orthodontic treatment. However, the extended duration of conventional methods often leads to patient dissatisfaction. In response, the surgery-first approach (SFA) has emerged as an alternative, aiming to streamline treatment and reduce complexity. This case report explores the implementation of the SFA without preoperative orthodontics, focusing on its integration with intermaxillary fixation (IMF) screws. A 25-year-old male presented with severe mandibular retrognathia and facial asymmetry. The radiographic evaluation confirmed the skeletal discrepancy, prompting a surgical solution. Utilizing three-dimensional (3D) planning software, LeFort I osteotomy for maxillary advancement and bilateral sagittal split osteotomy (BSSO) for mandibular setback was planned. IMF screws were strategically placed to stabilize the maxillomandibular complex intraoperatively. Immediate postoperative orthodontic adjustments-initiated dentition alignment and leveling. Regular follow-up ensured treatment progress and stability. The use of IMF screws in the surgery-first approach facilitated precise surgical movements, accelerated treatment timelines, and enhanced patient comfort. This adjunctive technique represents a promising avenue for improving surgical precision and patient outcomes in orthognathic surgery. Further research is warranted to explore the long-term stability and broader applicability of this approach across diverse patient populations.

In the dynamic landscape of digital healthcare and facial aesthetics, there is a rising demand for tools combining precision and accessibility. This article explores an innovative approach emphasizing accuracy and accessibility in facial aesthetic procedures through individualized planning and open-source software utilization. Digital facial analysis was conducted using facial photogrammetry capturing 16 simultaneous images in 0.4 seconds. The images were 3D reconstructed with Blender® software, incorporating selected points, angles, and measurements for facial analysis. Customizable points allowed individualized protocols, and additional measurements, such as the cervicomental angle, were included. Combinations of measurements were automated for comprehensive analysis. The data enabled the generation of a detailed digital facial analysis report, providing a precise and objective assessment. The approach demonstrated potential applications in maxillofacial surgery, plastic surgery, and simulation of dermal fillers and facial implants. Photogrammetry proved comparable to CT scans, eliminating human interference and enhancing accuracy. In the context of high patient expectations and evolving beauty standards, digital facial analysis offers valuable insights for aesthetic procedures. The integration of data into virtual surgical planning software enhances accuracy, but careful individualized planning and informed consent are crucial to manage expectations and legal considerations. This study underscores the role of open-source software, specifically Blender®, in democratizing access to advanced facial analysis tools. Blender's combination of precision and accessibility represents a paradigm shift, fostering innovation and personalized outcomes in facial aesthetic procedures.

The surgery-first approach (SFA) is gaining popularity in orthognathic surgery because it makes treatment duration shorter and more satisfying for patients. However, its effectiveness in complex cases isn't fully understood. Here, we describe a rare case where SFA was used to fix problems caused by missing posterior teeth and a deep bite, which made traditional pre-surgery orthodontic treatment impractical. A 34-year-old woman had facial asymmetry, bite issues, and trouble chewing due to a misaligned jaw. X-rays showed the problem, confirming that orthognathic surgery was needed. Planning for the surgery involved moving the upper jaw forward and the lower jaw backward, using specific bone-cutting techniques. The surgery, done with the patient under general anesthesia, went well. Orthodontic brackets were added during surgery which was aided by an orthodontist to make follow-up orthodontic treatment easier. The patient recovered uneventfully and saw improvements in how her face looked, how her teeth fit together, and how well she could chew. Later, more orthodontic work fine-tuned her bite, making sure the changes lasted and kept her satisfied. This case shows how combining orthodontics with the surgery-first method can be successful in orthognathic surgery. It brings benefits like shorter treatment times and immediate improvements in appearance. Our results match other recent studies that also found good outcomes with the surgery-first approach and quicker recovery times. While more research is needed, our case adds to the evidence that SFA can lead to successful orthognathic surgery results.

We aimed to assess the satisfaction level of patients with the outcome of genioplasty and the influential parameters in this respect.

This retrospective study was conducted on 70 patients between 18 to 59 years, who underwent genioplasty in the Oral and Maxillofacial Surgery Department at Shariati and Sina Hospitals, Tehran, Iran, between 2010 and 2020. Patient records were evaluated and a questionnaire was filled out over the phone to assess the influential parameters on the satisfaction level of patients with the outcome of genioplasty. Data were analyzed by PASS 11 (alpha=0.1).

Seventy patients were evaluated including 56 (80%) females and 14 (20%) males. Forty patients (52.6%) had no complaint with regard to the outcome of genioplasty. Postoperative chin deviation (not correcting the initial complaint) (10.52%), postoperative pain in the chin area (10.52%), and lower lip paresthesia (9.21%) were the most common patient complaints. The minimum and maximum satisfaction scores were 22 and 80, respectively. Number of follow-up sessions had a significant effect on satisfaction with the outcome of genioplasty (P=0.076). Patients who underwent advancement genioplasty alone had the highest level of long-term satisfaction with the outcome while those who underwent setback genioplasty alone had the lowest level of long-term satisfaction.

Advancement genioplasty had the highest rate of patient satisfaction, and chin asymmetry in the frontal view was the most common patient complaint after genioplasty.

The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred following LeFort I osteotomy, as well as the abnormalities of maxillary sinus volume (MSV) before and after the operation.

A systematic search was conducted on various databases, such as Google Scholar, PubMed, and Scopus. The articles used were in English and original. This study was conducted until September 2023, and after reviewing the articles, several keywords, such as "Maxillary sinus" and "LeFort I osteotomy", were employed. The obtained data were evaluated based on the PICO framework.

Findings from 15 studies showed that the amount of MSV decreased before and after the operation (considering the three dimensions of the sinus, the measurement was performed linearly). These reduction values differed between men and women, with men having a greater reduction. As is the case with other operations, there were some side effects associated with this type of operation that some patients experienced postoperatively.

In both male and female patients, the MSV was reduced after one-piece and multi-segment osteotomies. Nonetheless, one-piece LeFort I osteotomy showed a higher reduction in MSV than the multi-segment osteotomy method, according to this systematic review and meta-analysis.

Regarding the impact of orthognathic surgery on the airway and voice, this study was carried out to investigate the effects of maxillary impaction surgery on patients' voices through acoustic analysis and articulation assessment.

This quasi-experimental, before-and-after, double-blind study aimed at examining the effects of maxillary impaction surgery on the voice of orthognathic surgery patients. Before the surgery, a speech therapist conducted acoustic analysis, which included fundament frequency (F0), Jitter, Shimmer, and the harmonic-to-noise ratio (HNR), as well as first, second, and third formants (F1, F2, and F3). The patient's age, sex, degree of maxillary deformity, and impaction were documented in a checklist. Voice analysis was repeated during follow-up appointments at one and six months after the surgery in a blinded manner. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05.

Twenty two patients (18 females, 4 males) were examined, with ages ranging from 18 to 40 years and an average age of 25.54 years. F2, F3, HNR, and Shimmer demonstrated a significant increase over the investigation period compared to the initial phase of the study (P <0.001 for each). Conversely, the Jitter variable exhibited a significant decrease during the follow-up assessments in comparison to the initial phase of the study (P< 0.001).

Following maxillary impaction surgery, improvements in voice quality were observed compared to the preoperative condition. However, further studies with larger samples are needed to confirm the relevancy.

Sagittal split ramus osteotomy is one of the most efficient steotomy techniques for orthognathic surgery.  This technical note presents a new technique of mandibular osteotomy to prevent bony interferences  with simultaneous maxillary impctions. As well as increase in bone contact for great mandibular  advancements which results in better bone healing. furthermore, Fixation of bony segments in  this area is far from third molar alveolar socket if extraction is done and is not involved in the process.

BDD is a psychiatric diagnosis in the spectrum of obsessive compulsive disorder wherein the patient has a damaging mental preoccupation with a slight deficiency in his physical appearance. Awareness of this disease and its symptoms is essential for proper diagnosis and management of the patient.

This cross-sectional study was performed on 86 patients who underwent orthognathic surgery. A demographic information questionnaire, Yale-Brown Obsessive Compulsive Scale modified for the BDD questionnaire, BDI-II questionnaire (Depression Scale) and Beck Anxiety Scale questionnaire were completed by patients to assess BDD disorder, depression, and anxiety. Data were described using appropriate statistical tables and graphs to express indicators and frequency distribution. Shapiro-Wilk, Mann-Whitney, Kruskal-Wallis, and Fisher tests were used to analyze the data.

This study was performed on 86 patients with a mean age of 23.19±4.5 years. The percentage of BDD in women (20%) was higher than in men (14%), but this difference was not statistically significant (p=0.685). The prevalence of depression was significantly higher (p<0.001) in patients with BDD (53%) than in those without this disorder (11%). The prevalence of anxiety was significantly higher (p<0.001) in patients with BDD (67%) than in those without this disorder (23%). With increasing age, the BDD scores decrease slightly, but this difference was not statistically significant (p=0.113).

The prevalence of BDD in the study population was 17.4%. The high prevalence of the disorder in orthognathic surgery patients compared to the general population requires the serious attention of dentists to this disorder.

The purpose of the present study was to evaluate the accuracy of Dolphin Imaging version 11.8 software, in predicting soft and hard tissue changes after orthognathic jaw surgery.

In this retrospective study, pre- and postoperative cephalograms and photographs of 20 patients were scanned and inserted into Dolphin Imaging version 11.8 software and traced by the software. Cephalometric superimposition was performed before and after the operation to determine the extent of changes in each jaw. The software then simulated postoperative images according to the calculated changes for each patient.

The results of this study showed that the upper lip had the highest accuracy in both sagittal and vertical axes. The highest reliability was in the upper lip with 80% error in the sagittal axis and the tip of the nose with 80% error in the vertical axis. The lowest accuracy in our study was related to soft tissue Menton which had the least reliability with an error frequency of 35% and 45% in the sagittal and vertical axis, respectively.

Based on the method used and the findings obtained by digital measurements, it can be concluded that the Dolphin Imaging version 11.8 software can be used to reliably predict hard tissue as well as soft tissue, especially in the upper lip area.

Bilateral sagittal split ramus osteotomy is one of the most versatile techniques in orthognathic surgery that allows for the repositioning of the mandible in all directions. This osteotomy splits the mandible into two proximal condyle-bearing segments and one distal tooth-bearing segment.Intraoperatively, the surgeon is usually focused primarily on the proper positioning of the distal segment to achieve the planned amount of advancement or setback. However, particular attention should be paid to the position of the proximal segment, as improper positioning of the proximal segment during fixation gives rise to immediate or late relapse of the surgical outcomes. The goal of this paper is to provide some background knowledge about the proximal segment for the novice surgeons, based on a review of the relevant literature. What is the proper position of the proximal segment, and what is the best technique to guide the proximal segment into its proper position?. These questions do not have clear-cut answers that the majority of surgeons agree on.

Considering the side effects of high doses of opioids taken postoperatively for pain control, paracetamol and magnesium sulfate may be able to aid in pain control. This study assessed the effects of paracetamol and magnesium sulfate on the level of pain and opioid intake following orthognathic surgery.   

In this double-blind randomized clinical trial, patients scheduled for bimaxillary orthognathic surgery were randomly assigned to two groups of 25. Group 1 patients received 1 g infusion of intravenous acetaminophen (paracetamol) administered within 20 minutes while group 2 patients received 50 mg/kg magnesium sulfate infusion one hour prior to completion of surgery. The patients were asked to express their level of pain prior to discharge from the recovery, and every 4 hours for 12 hours using a visual analog scale (VAS). Patients with pain score > 5 at any time received 30 mg pethidine. The total received dosage of pethidine postoperatively was recorded and those that received pethidine were not included in pain score analysis. Data were analyzed by generalized estimating equation (GEE), and Mann-Whitney U, Chi-square, and t-tests.

The pain score was not significantly different between the two groups at the time of recovery and 4 and 8 hours (P>0.05). The magnesium sulfate group had significantly lower pain score at 12 hours (P=0.009). The difference in pethidine dosage was not significant (P>0.05).

Both magnesium sulfate and paracetamol decreased postoperative pain and the need for opioid consumption, but magnesium sulfate was slightly more effective.

We aimed to compare the emergence from anesthesia between the isolated mandibular setback and bimaxillary orthognathic surgeries in Skeletal Class III Patients.

All healthy patients with skeletal class III deformity admitted to Mashhad Dental School, Mashhad, Iran from the years 2017 to 2018 were included in this study. They were candidates for either bimaxillary orthognathic surgery (Bimax surgery) through a combination of mandibular setback surgery plus maxillary advancement or isolated mandibular setback (Monomax surgery). The predictor variable was the type of jaw displacement and anesthesia duration, while the outcome variable was the duration of emergence from general anesthesia. The duration of emergence from anesthesia was calculated from the time the patient was transported to the recovery room until the time of safely discharging from the recovery room. For statistical analysis, the significance level was set at 0.05 using SPSS 21.

A total of 81 consecutive patients, comprising 45 (55.6%) males and 36 (44.4%) females, with an average age of 23.15±4.58 years were recruited. Among the participating patients, 56 (69.1%) underwent bimaxillary surgery while the other 25 (30.9%) were treated with Monomax surgery. Regardless of the type of performed surgery, the duration of general anesthesia was the only factor to be significantly correlated to the length of emergence from anesthesia (P= 0.001). 

Increased exposure time to general anesthesia might result in a longer emergence from anesthesia, despite the type of performed orthognathic surgery. Further clinical trials are needed to support the relevancy.

Patients' attitudes about their nose changes after orthognathic surgeries. We aimed to evaluate the patient's opinion about nasal change and morphologic changes following orthognathic surgery.

This was a cross-sectional study. The sample was derived from the population of patients who underwent orthognathic surgery in the Oral and Maxillofacial Surgery Department of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2019. Subjects who underwent orthognathic surgery were studied. Subjects filled a modified nose evaluation form before and nine months after orthognathic surgery. For objective assessment, the nasolabial angle, nasofrontal angle, nasofacial angle, tip projection, and tip deviation and alar width were evaluated. Sixty-two patients were studied.

Forty (64.5%) patients did not absolutely like their nose before orthognathic surgeries, two (3.2 %) expressed a little satisfaction, 17(27.4%) answered they liked more or less, and three liked very much. Nine months after orthognathic surgeries, 4 (6.5%) patients did not like their nose, nine patients (14.5%) liked a little, 30 (48.4%) liked more or less, and 19 liked very much. Analysis of the data demonstrated a significant difference in patients' satisfaction with their noses before and nine months after orthognathic surgeries (P<0.001). Patients’ satisfaction nine months after orthognathic surgery was not affected by nasal morphologic changes.

It seems, patients' satisfaction with their nose improved after orthognathic surgeries. Patients' attitude was not associated with nasal morphologic changes.

Bilateral Sagittal Split Osteotomy (BSSO) is one of the treatment options for Class III maxillary deficiency which may affect the condylar position and the patient's occlusion. We aimed to evaluate the clinical and radiographic changes of temporomandibular joint (TMJ) following mandibular set back surgery by BSSO.

In this retrospective study, All Class III patients, aged between 18-30 years old who underwent bimaxillary orthognathic surgery in the Oral and Maxillofacial Surgery Ward of Ghaem Hospital, Mashhad, Iran from January 2018- January 2020 were enrolled. Radiographic changes of joint space, condylar position and clinical changes for maximal mouth opening and joint sound were examined before and 6 months after surgery. Data were analyzed by SPSS16 software and the significance level of the data was set at P-value < 0.05.

Twenty-five patients were recruited. The axial angle of the left and right condyle and condylar inclination on both sides reduced but this reduction was not statistically significant. While the anterior joint space was reduced and posterior joint space was increased in both sides, the changes on the right side were only significant (P = 0.039). In clinical examinations maximum mouth opening, lateral and protrusive movements were also decreased but this reduction was not statistically significant.

The mandibular set back with BSSO surgery in class III skeletal patients had no significant effect on the position of the condyle in the glenoid fossa as well as clinical symptoms.

This study aimed to review the articles comparing orthodontic first (OFA) and surgery first approaches (SFA) orthognathic approaches from various treatment aspects of patients with class III skeletal malocclusion.

Electronic databases were systematically searched, including PubMed, Scopus, and Web of Science. We included experimental cohort and retrospective studies that compared the orthodontics first (conventional method) and surgery first approaches in the management of patients with skeletal class III malocclusion in various aspects.

Overall, 294 records were found through database searching and after removing duplicates, 131 papers were investigated. Finally, 17 studies were included in this study. The included studies have evaluated vast spectroum of outcome measures ranging from quality of life and duration of treatment to cephalometric measures. The amount of surgical movement, post-surgical change, and the relapse rate was the most prevalent assessed outcome measure in 10 out of 17 included studies, followed by total treatment time, which was evaluated in 8 studies. Other less common outcome measures were temporomandibular joint (TMJ) disorders and the oral health-related quality of life (OQLQ) questionnaire.

Two OFA and SFA orthognathic surgery approaches are not different in terms of the final amounts of surgical change in the mandible and maxilla. Also, these two approaches can remarkably improve the quality of life with no intergroup differences. It was realized that there are no united agreements on the effects of two OF and SF approaches on the outcomes the patients with class III skeletal malocclusions.

A notable proportion of class II population suffer from excessive vertical maxillary growth which leads to subsequent backward rotation of mandible. Excessive tooth show at rest and on smile are the associated presentation of this group.we report treatment results of this subdivision of class II patients, treated by high pull headgears attached to maxillary acrylic splints with posterior bite-blocks.in all cases, maxillary vertical & sagittal growth had been controlled and simultaneous vertical mandibular growth contributed to improvement of facial profile, incisor show, lip and mentalis muscle function.considering every aspect of an individual’s growth pattern is an inevitable step in treatment planning in orthopedic patients, as it may play a direct role in the treatment plan and mechanotherapy. Comprehensive diagnosis and a customized treatment plan is the key to clinical success.