Explore the vast range of titles available.

Wiley-Blackwell's Clinical Cases series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic backbone. Clinical Cases in Orthodontics applies both theory and practice to real-life orthodontic cases in a clinically relevant format. This unique approach supports the new trend in case-based and problem-based learning, thoroughly covering topics ranging from Class I malocclusions to orthognathic surgery. Highly illustrated in full color, Clinical Cases in Orthodontics' format fosters independent learning and prepares the reader for case-based examinations.

The purpose of this study was to present and validate an innovative semi-automatic approach to quantify the accuracy of the surgical outcome in relation to 3D virtual orthognathic planning among patients who underwent bimaxillary surgery. For the validation of this new semi-automatic approach, CBCT scans of ten patients who underwent bimaxillary surgery were acquired pre-operatively. Individualized 3D virtual operation plans were made for all patients prior to surgery. During surgery, the maxillary and mandibular segments were positioned as planned by using 3D milled interocclusal wafers. Consequently, post-operative CBCT scan were acquired. The 3D rendered pre- and postoperative virtual head models were aligned by voxel-based registration upon the anterior cranial base. To calculate the discrepancies between the 3D planning and the actual surgical outcome, the 3D planned maxillary and mandibular segments were segmented and superimposed upon the postoperative maxillary and mandibular segments. The translation matrices obtained from this registration process were translated into translational and rotational discrepancies between the 3D planning and the surgical outcome, by using the newly developed tool, the OrthoGnathicAnalyser. To evaluate the reproducibility of this method, the process was performed by two independent observers multiple times. Low intra-observer and inter-observer variations in measurement error (mean error < 0.25 mm) and high intraclass correlation coefficients (> 0.97) were found, supportive of the observer independent character of the OrthoGnathicAnalyser. The pitch of the maxilla and mandible showed the highest discrepancy between the 3D planning and the postoperative results, 2.72° and 2.75° respectively. This novel method provides a reproducible tool for the evaluation of bimaxillary surgery, making it possible to compare larger patient groups in an objective and time-efficient manner in order to optimize the current workflow in orthognathic surgery.

Surgical site infections (SSI) occur in 1.4% to 33.4% of cases after orthognathic surgery. This type of complication is a major concern to surgical teams, but there is no consensus for the prevention and treatment of SSI in orthognathic surgery. The purpose of this descriptive study was to evaluate the severity and the consequences of postoperative infections. The charts of all the patients operated on by the orthognathic surgery team between January 2015 and July 2017 were collected. All types of orthognathic procedures (Le Fort I maxillary osteotomy, bilateral sagittal split mandibular osteotomy, and genioplasty) were screened, and patients diagnosed with SSI were included. Demographic data, timing and severity of the infection, as well as long-term complications were recorded. Five hundred and twelve patients were screened. Forty-one patients (8%) presenting with SSI were included. There were 18 men and 23 women. The site of the infection was mandibular for 38 patients (92.7%) and maxillary for 3 patients (7.3%). The average time between surgery and infection was 31.5 days. Twenty-four patients received isolated oral antibiotics for inflammatory cellulitic reaction (58.8%), 15 patients had a localized collection treated by incision and drainage under local anesthesia (36.6%), and 2 patients had an extensive collection requiring surgical drainage under general anesthesia (4.9%). Five patients (12.2%) needed hardware removal for plate loosening, and 2 patients (4.9%) developed chronic osteomyelitis. Infection following orthognathic surgery is easily treated most of the time with no long-term complications. In cases of patients with potential risk factors for severe infection, antibiotics may be given with curative intents.

ObjectiveThis systematic review evaluated the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of orthodontic camouflage (OC) versus orthodontic-orthognathic surgical (OOS) treatment in borderline class III malocclusion patients.MethodsEligibility criteria. The included studies were clinical trials and/or follow-up observational studies (retrospective and prospective). Information sources. PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS were searched up to October 2021. Risk of bias. Downs and Black quality assessment checklist was used. Synthesis of results. The outcomes were the skeletal, dentoalveolar, and soft tissue changes obtained from pre- and post-cephalometric measurements.ResultsIncluded studies. Out of 2089 retrieved articles, 6 were eligible and thus included in the subsequent analyses. Their overall risk of bias was moderate. Outcome results. The results are presented as pre- and post-treatment values or mean changes in both groups. Two studies reported significant retrusion of the maxillary and mandibular bases in OC, in contrast to significant maxillary protrusion and mandibular retrusion with increased ANB angle in OOS. Regarding the vertical jaw relation, one study reported a significant decrease in mandibular plane inclination in OC and a significant increase in OOS. Most of the included studies reported a significant proclination in the maxillary incisors in both groups. Three studies reported a significant proclination of the mandibular incisors in OOS, while four studies reported retroclination in OC.ConclusionInterpretation. The OSS has a protrusive effect on the maxillary base, retrusive effect on the mandibular base, and thus improvement in the sagittal relationship accompanied with a clockwise rotational effect on the mandibular plane. The OC has more proclination effect on the maxillary incisors and retroclination effect on the mandibular incisors compared to OOS. Limitation. Meta-analysis was not possible due to considerable variations among the included studies. Owing to the fact that some important data in the included studies were missing, conducting further studies with more standardized methodologies is highly urgent. Registration. The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199591).Clinical relevanceThe common features including skeletal, dental, and soft tissue characteristics of borderline class III malocclusion cases make it more difficult to select the most appropriate treatment modality that can be either OC or OOS. The availability of high-level evidence—systematic reviews—makes the clinical decision much more clear and based on scientific basis rather than personal preference.

This handbook provides a short, contemporary text on the management of dentofacial deformities. The importance of a well organised, inter-disciplinary approach is emphasised throughout and the following key areas are presented: * A detailed account of the role of the psychologist, from initial assessment through to post-operative support. * A systematic approach to dentofacial assessment, including a section on diagnostic records and an overview of cephalometry. * A logical step-by-step approach to treatment planning, emphasising the interactive thought process required when setting orthodontic and surgical objectives. * The fundamentals of surgical orthodontics, with the scope and limitations of orthodontic appliances clearly explained for each phase of treatment. * A description of orthognathic technical procedures and how potential errors can be minimised in order to improve the accuracy of model surgery. * An account of how to carry out photo-cephalometric profile prediction planning, including a critique of the method. * A detailed description of the full range of mandibular and maxillary orthognathic surgical procedures, including indications and complications. * A chapter on higher-level osteotomies for the treatment of more severe craniofacial abnormalities is included for completeness. * A series of six contrasting case studies. There is an emphasis on the technological advances that are rapidly enabling the global paradigm shift from 2D to 3D planning.

Orthognathic surgery entails a high risk of blood ingestion, which causes postoperative nausea and vomiting (PONV). Throat packs are placed to combat this problem. However, the efficacy of throat packs in reducing blood ingestion and PONV is debatable. We aimed to review the existing literature and pool the estimates of the quality of gastric contents, PONV, and throat pain associated with and without the use of throat packs among patients undergoing orthognathic surgery. Globally recognized databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) were searched to identify relevant studies, and 2 randomized controlled trials comprising 84 participants were included. A qualitative analysis of the gastric contents showed that throat packs are not practical barriers against the ingestion of blood during orthognathic surgery. The meta-analysis revealed that placement of throat packs during orthognathic surgery did not reduce the incidence of PONV ( value = 1) and caused higher postoperative throat pain ( value = 0.02). Thus, the current review provides no evidence in favor of throat packs during orthognathic surgery. The role of throat packs in preventing blood ingestion is questionable due to a limited number of studies. They play no significant role in preventing PONV and increase postoperative throat pain.

Current computational tools for planning and simulation in plastic and reconstructive surgery lack sufficient precision and are time-consuming, thus resulting in limited adoption. Although computer-assisted surgical planning systems help to improve clinical outcomes, shorten operation time and reduce cost, they are often too complex and require extensive manual input, which ultimately limits their use in doctor-patient communication and clinical decision making. Here, we present the first large-scale clinical 3D morphable model, a machine-learning-based framework involving supervised learning for diagnostics, risk stratification, and treatment simulation. The model, trained and validated with 4,261 faces of healthy volunteers and orthognathic (jaw) surgery patients, diagnoses patients with 95.5% sensitivity and 95.2% specificity, and simulates surgical outcomes with a mean accuracy of 1.1 ± 0.3 mm. We demonstrate how this model could fully-automatically aid diagnosis and provide patient-specific treatment plans from a 3D scan alone, to help efficient clinical decision making and improve clinical understanding of face shape as a marker for primary and secondary surgery.

Background and Objectives: Despite the well-established position of orthognathic surgery as a field of surgical treatment of deformities within the facial skeleton, it has not been possible to develop unanimous recommendations on how to approach fixation hardware after the healing period. In the absence of clear guidelines from opinion leaders and scientific societies on how to approach osteosynthesis after surgery, the decision to leave or remove fixation hardware is made individually by treatment centers, mostly based on their own experience. It is also important whether or not surgical procedures are financed by public funds. This issue extends beyond orthognathic surgery, affecting all facial skeleton procedures involving osteosynthesis materials. The aim of this study is to analyze the frequency and reasons for fixation hardware removal after orthognathic surgery in patients treated in one center. Materials and Methods: This retrospective study examined the medical records from 2015 to 2020 of patients treated surgically for skeletal deformities at the Department and Clinic of Otolaryngology and Maxillofacial Surgery of Collegium Medicum (formerly the Otolaryngology Department of the Provincial Hospital in Zielona Góra). This study analyzed the age and sex of patients, the type of orthognathic procedure, and the type of skeletal deformity, as well as the reasons for fixation hardware removal in the groups of patients. Results: During this period, 124 orthognathic procedures were performed, including 56 one-jaw operations (BSSO or Le Fort I maxillary osteotomy), 2 one-jaw operations with genioplasty, 55 bimaxillary operations (BSSO + Le Fort I maxillary osteotomy), 6 bimaxillary surgery with genioplasty and 5 isolated genioplasty procedures. Fixation hardware was removed in 77 cases (62.10% of procedures), comprising 57 women and 20 men. Reasons for osteosynthesis removal were divided into three groups: complications such as the occurrence of inflammatory reaction/infection (n = 17), subjective discomfort (n = 23), and patient requests (n = 37). Conclusions: The findings underscore the need for scientific societies to establish unified guidelines on managing post-surgical fixation hardware to standardize care and enhance patient outcomes.

BackgroundDouble-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery.MethodsIn this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS).ResultsCompared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of −20.1 (95% CI −37.4 to −2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of −28.7 (95% CI −55.9 to −1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson’s correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively).ConclusionBilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery.Trial registration numberNCT05351151.

Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D planning.