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Orthognathic surgery (OS) has become a widely used treatment option for moderate to severe dento-skeletal malocclusions. The aim of this study was to analyze the incidence and time trends of OS and potential influencing factors in the German healthcare system. Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. We estimated age-gender standardized incidence of OS-associated procedures between 2005 and 2022 and evaluated age- and gender-adjusted time trends using Poisson regression analysis. The total standardized incidence rate of OS-associated procedures in the observational period 2005–2022 was 11.1 (♀13.0; ♂ 9.2) per 100,000 person years. A significant increase of 61.8% (♀+48.7%; ♂+82.9%) in OS-associated procedures was observed within the observational period, mainly due to the increase of the procedures in the age groups 15–34 years (+ 53.6%), 35–59 years (+ 66.7%) and 60–79 years (+ 20.0%). Mandibular procedures increased by 45.0%, while maxillary procedures increased by 88.2%. There were significant differences of the incidence of OS-associated procedures between the various federal states in Germany, indicating a higher incidence and stronger increase in more affluent regions. The age- and gender-standardized incidence of OS-associated procedures increased among all genders and the most relevant age groups in Germany in the last two decades. There is an ongoing trend to implement maxillary and combined procedures. These effects are limited to more affluent regions only, reflecting the impact of socioeconomic and regional factors on healthcare accessibility.

Condylar resorption is a feared complication of orthognathic surgery. This study investigated condylar resorption in a cohort of 200 patients This allowed for a powerful update on incidence and risk factors. 9.5% of patients developed resorption. These patients had on average, 17% volume loss with 3.9 mm ramal height loss and 3.1 mm posterior mandibular displacement. 2% of patients had bilateral resorption. Univariable analysis identified a younger age, a bimaxillary + genioplasty procedure, larger mandibular advancements, upward movements of the distal segment, a higher counterclockwise pitch of the distal segment, smaller preoperative condylar volumes and a higher anterior/posterior lower facial height ratio as risk factors on a patient level. Univariable analysis on a condylar level also identified compressive movements of the ramus and a higher mandibular plane angle as risk factors. Using machine learning for the multivariable analysis, the amount of mandibular advancement was the most important predictor for condylar resorption. There were no differences in preoperative mandibular, ramal or condylar shape between patients with or without resorption. These findings suggest condylar resorption may be more common than thought. Identifying risk factors allows surgical plans to be adjusted to reduce the likelihood of resorption, and patients can be more selectively screened postoperatively.

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.

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 ( p value = 1) and caused higher postoperative throat pain ( p 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.

Superimposition of two dimensional preoperative and postoperative facial images, including radiographs and photographs, are used to evaluate the surgical changes after orthognathic surgery. Recently, three dimensional (3D) imaging has been introduced allowing more accurate analysis of surgical changes. Surface based registration and voxel based registration are commonly used methods for 3D superimposition. The aim of this study was to evaluate and compare the accuracy of the two methods. Pre-operative and 6 months post-operative cone beam CT scan (CBCT) images of 31 patients were randomly selected from the orthognathic patient database at the Dental Hospital and School, University of Glasgow, UK. Voxel based registration was performed on the DICOM images (Digital Imaging Communication in Medicine) using Maxilim software (Medicim-Medical Image Computing, Belgium). Surface based registration was performed on the soft and hard tissue 3D models using VRMesh (VirtualGrid, Bellevue City, WA). The accuracy of the superimposition was evaluated by measuring the mean value of the absolute distance between the two 3D image surfaces. The results were statistically analysed using a paired Student t-test, ANOVA with post-hoc Duncan test, a one sample t-test and Pearson correlation coefficient test. The results showed no significant statistical difference between the two superimposition methods (p<0.05). However surface based registration showed a high variability in the mean distances between the corresponding surfaces compared to voxel based registration, especially for soft tissue. Within each method there was a significant difference between superimposition of the soft and hard tissue models. There were no significant statistical differences between the two registration methods and it was unlikely to have any clinical significance. Voxel based registration was associated with less variability. Registering on the soft tissue in isolation from the hard tissue may not be a true reflection of the surgical change.

Purpose The aim of this retrospective study was to determine orthognathic surgery indicators for Japanese patients with jaw deformities using both Index of Orthognathic Functional Treatment Needs (IOFTN) and maxillofacial morphometric analysis. Subjects and methods The subjects were 89 patients treated with orthognathic surgery and 92 patients treated with orthodontic treatment alone, and were classified as class I, II, or III according to the ANB angle. Based on the results for IOFTN and the results of cephalometric analysis, the indication criteria for orthognathic surgery were examined. Results In IOFTN analysis, none of patients in the orthognathic surgery group were classified as category 1 or 2, while 48% of the patients in the orthodontic treatment group were classified as category 4 or 5. The results of the cephalometric analysis of patients in classified categories 4 and 5 showed that the orthognathic surgery group had significantly greater lateral mandibular deviation in Class I cases, significantly more severe degree of mandibular retrusion in Class II cases, and significantly more severe degree of mandibular prognathism in Class III cases. The results of the logistic regression analysis showed that IOFTN was a common variable as an indication criterion for orthognathic surgery, and several different variables were also selected from the cephalometric measurements in each group. Conclusion IOFTN is a highly sensitive and useful indicator as a criterion for orthognathic surgery. However, in the choice of treatment strategy, maxillofacial morphometric analyses and the patient's desired goal are important.

Importance Orthognathic surgery is utilized to rectify facial deformities, but it can lead to neurosensory alterations. Electroacupuncture has been shown to enhance sensitivity and motor functions in patients post-surgery. However, its application in traumatic facial injuries remains inadequately researched. Objective To investigate the effects of electroacupuncture on sensitivity and orofacial function in patients undergoing orthognathic surgery. Design, Setting, and Population A randomized clinical trial involving patients undergoing bimaxillary orthognathic surgery and genioplasty who are randomly allocated to either a physiotherapy (PT) or physiotherapy plus electroacupuncture group (PTEA). Exposures Participants will be allocated to their respective therapies for a duration of six weeks. The PT group will receive a 50-minute physical therapy session along with 30 minutes of simulated procedure. The PTEA group will receive 50 minutes of physical therapy followed by 30 minutes of electroacupuncture. Main Outcomes and Measures Before treatment, sensitivity will be assessed using the SMILE Sensitivity Test-BAURU kit, edema will be evaluated using the MD Anderson Cancer Center Head and Neck Lymphedema protocol, range of motion will be measured using a digital caliper, and muscle pain and fatigue will be gauged using numerical scales. The chewing function will be evaluated using the Chewing Quality Assessment Questionnaire. Results All assessments will be repeated at three and six months following the initiation of treatment. Conclusions and Relevance This study may provide reliable and high-quality clinical evidence regarding the impact of electroacupuncture on restoring altered sensation and motor function in patients undergoing orthognathic surgery.

Bimaxillary surgery is a painful invasive procedure in plastic surgery. Pain control is typically achieved using intravenous analgesics. We aimed to investigate the efficacy of a novel temperature-responsive hydrogel, PF72, mixed with ropivacaine, as a local pain management solution when applied directly to the surgical site following orthognathic surgery. The study was conducted from October 2022 to July 2023 and included a cohort of 40 candidates for orthognathic surgery, encompassing LeFort I maxillary ostectomy and sagittal split ramus osteotomy. The participants were divided into an Injection group (n = 20), where PF72 was administered at the surgical site before the orthognathic surgery, and a Control group (n = 20), which relied solely on intravenous analgesics. Pain was evaluated at 3, 6, 24, 48, and 72 h after surgery using a numerical rating scale (NRS). The mean NRS scores at 24 h were 6.35 and 4 for the Control and Injection groups, respectively. The mean NRS scores at 72 h were 3.4 and 2.55 for the Control and Injection groups, respectively. Patients who received PF72 experienced less pain than those who received intravenous analgesics. These findings underscore the potential of PF72 as an effective alternative for enhancing pain management in patients undergoing orthognathic surgery. Level of Evidence III Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: This study was aimed at reviewing the application of different artificial intelligent algorithms used in different phases of orthognathic surgeries, which include diagnosis, treatment planning, soft tissue prediction, outcome evaluation, and complication assessment. This aimed to update clinicians on this technology to integrate it into their decision‐making, in addition to being aware of its challenges and potential areas for further assessment. Materials and Methods: Electronic search was done in PubMed, Scopus, Embase, and Cochrane databases. Studies that reported the application of artificial intelligence (AI) in different aspects of orthognathic surgery were included. Results: From 656 studies, a total of 29 articles met the inclusion criteria and were used to categorize the application of AI as follows: (1) Diagnosis in which studies showed the sensitivity of 75%–95.5% for specifying the need for orthognathic surgery; (2) treatment planning in which AI was used for osteotomy design and bony reference point determination with 3.99–4.73 mm of error; (3) soft tissue prediction in which AI models showed a success rate of 64.3%–100%; (4) outcome evaluation in which AI was used to assess the impact of surgery on asymmetry, facial attractiveness, and esthetic improvements quantitatively; and (5) complication assessment with an accuracy of 98.7% for predicting postsurgical systemic infection and 7.4 mL of error for blood loss. Conclusion: AI can be potentially considered as a proper alternative to conventional approaches to fasten the procedure related to orthognathic surgery and with comparable accuracy to conventional methods.

This study aims to investigate whether a systematic digital training system can improve the learning efficiency of residents in the first-year orthognathic surgery training course and evaluate its effectiveness in teaching orthognathic surgery. A digital training system was applied, and a comparative research approach was adopted. 24 first-year orthognathic surgery residents participated in the experiment as part of their professional skill training. The Experimental group was required to use a digital training system, and the Control group was trained in lectures without digital technologies. Three indicators, including theoretical knowledge and clinical operation, were assessed in tests, and evaluations from instructors were analyzed to evaluate learning efficiency. The results showed that the scores in theoretical tests, practical operations, and teacher evaluations, the Experimental groups were all higher than the Control group (  = 0.002 for anatomy,  = 0.000 for operation theory) after using digital technology, except for the understanding of complications (  = 0.771). In addition, the questionnaire survey results showed that the study interest (  = 0.001), self-confidence (  = 0.001), satisfaction (  = 0.002), and academic performance (  = 0.001) of the residents of the Experimental group were higher than those of the Control group. The outcomes indicated that the digital training system could benefit orthognathic residents' learning efficiency, and learning interest and teaching satisfaction will also improve.