Current Trends in Orthognathic Surgery in Poland—A Retrospective Analysis of 124 Cases

Round 1

Reviewer 1 Report

This paper discussed the benefits of a new trends in orthognathic surgery. The authors describe an experimental technique to evaluate the effect orthognathic surgery in 124 cases.
Overall, the study has been designed and executed in an adequate manner. I recommend that this paper should be accepted after minor revision.
TITLE:
The title is appropriate.
ABSTRACT:
The authors state that the aim of the study was to determine the efficacy and the evaluation of this surgery. I would suggest more details of the surgical technique in the abstract.
INTRODUCTION:
The introduction is clear, cites relevant references and gives a good overall context of the research question. I would suggest to cite also one article regarding the patients' related outcome because this surgery must be less invasive as possible and also influence in a positive manner the quality of life of the patients. In this case I suggest to cite the following article:

Cosola S, Marconcini S, Giammarinaro E, Poli GL, Covani U, Barone A. Oral health-related quality of life and clinical outcomes of immediately or delayed loaded implants in the rehabilitation of edentulous jaws: a retrospective comparative study. Minerva Stomatol. 2018 Oct;67(5):189-195. doi: 10.23736/S0026-4970.18.04134-1. Epub 2018 Apr 16. 

MATERIALS AND METHODS:
The materials and methods part is detailed and provides the reader with enough information to replicate the study. Information regarding selection, age and relevant history of the patients is sufficient. The research question is clearly formulated and addressed properly.
Please specify which radiologic assessment method was used.
What was the sample size and which software has been used to calculate it?
Please report more precisely on the developer of the programs used and the statistics.

RESULTS
The resulting data has been presented clear to the reader, enabling to formulate conclusions.
The included patients should be evaluated in all anamnestic aspect as well.
DISCUSSION
The key findings of the study are consistent with the results of the authors. Implementations and future research questions have been formulated.

TABLES AND FIGURES
Tables and figures are easy to read and understand. The figures support the reported results.
Minor corrections in the legends of the tables and figures are suggested.

Further minor suggestions for correction are highlighted in the pdf document.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer,

Thank you for reading our manuscript and reviewing it, which will help us improve it to better scientific level. We have made correction which we hope meet your approval. We added more details of surgical techniques in the abstract. We find the article you have suggested very interesting. We improved our references by citing it. We modified legends of tables ang figures. We also specified the radiologic method and software that we used for measures and statistics. The diagnosis of skeletal malocclusion was based on the patient's clinical examination and the use of diagnostic instruments such as facial photographs, cone beam computed tomography (CBCT) examinations of the skull, dental arch scans, and soft tissue cephalometric analysis (STCA) using NemoFab software (NEMOTEC, Spain). The soft tissue cephalometric analysis STCA (introduced by William Arnett) was performed on the lateral cephalograms generated from CBCT. The statistical analysis of the results was performed using STATISTICA v. 13.3 (TIBCO Software Inc.)

We have sent revised manuscript and a version containing all the changes to be visible.

Yours Sincerely,

Authors

Reviewer 2 Report

Manuscript ID: applsci-1251217

 Current trends in orthognathic surgery—a retrospective analysis of 124 cases

The description of this article is clear and the results are consistent. I think a small modification is acceptable.

1. The introduction should be described in sections, not in a single sentence.
2. It is recommended that Figures 1-3 should be merged together and the differences should be marked.
3. Table 1. It should be rearranged to make it easier to understand.
4. Figure 7-8 should be supplemented with the representatives of A-F.
5. This study should show the Human Body Research Certificate (IRB), not the "World Medical Association Declaration of Helsinki".

Author Response

Dear Reviewer,

Thank you for reading our manuscript and reviewing it, which will help us improve it to better scientific level. We have made correction which we hope meet your approval. We rearranged the Table 1 to make it easier to understand, we modified legends of Figures 7 and 8. We divided the introduction into section: Historical development of orthognathic surgery, Contemporary aspects of orthognathic surgery and Aim of the study. We have sent revised manuscript and a version containing all the changes to be visible.

Yours Sincerely,

Authors

Reviewer 3 Report

There are some critical issues in the article that I think should be corrected before the final publication

The classification used to define the different skeletal deformities is insufficient. The proposed classification does not consider as a separate category the real maxillo-mandibular asymmetries in which it is not possible to say whether they are II or III classes nor the short face syndrome. In this case series of more than 120 consecutive cases it is not possible that these two deformities are not present.

It would also seem particularly interesting if the authors could enter the percentage of total intraoperative complications (bad splitting mandibular, lacerations of the laveolar nerve etc.)

As far as post-operative nerve complications it would have been very important and interesting to check a possible correlation both with the length of surgical time and with the association of mandibular osteotomy and genioplasty or if this complication is independent of these two variables 

finally, with regard to the timing of the different surgeries, it is necessary to specify whether they are always referred to experienced surgeons or surgeons in training since the structure where they are performed is a university structure

Author Response

Dear Reviewer,

Thank you for reading our manuscript and reviewing it, which will help us improve it to better scientific level. We have made correction which we hope meet your approval.
All the patients were operated by two experienced maxillofacial surgeons.
Data collection for this retrospective study was based on surgical protocols. In the material under study there were no severe asymmetries that could disturb the assessment of class II or class III.
We added details about the intraoperative complications in discussion. In the study, the intraoperative complications were identified in 10 patients (8%), of which 3 patients with a bad split in the sagittal split osteotomy, 2 patients with inferior alveolar nerve laceration, 2 patient with increased bleeding during the surgery, 2 patient with dental injury and 1 patient with rupture of the hard palate mucosa during segmentation. Postoperative complications were beyond the scope of this study.

We have sent revised manuscript and a version containing all the changes to be visible.

Yours Sincerely,

Authors

Reviewer 4 Report

Dear Authors, 

The manuscript is very interesting, except for the epidemiological data on how often you are having this surgery in Zielona Gora. What is information for the international readers which can be interesting? Please improve.

The title of the manuscript should include the territory of your analysis – in Poland.

All the tables in which you are showing the statistical analysis should have shown p<0.05

Author Response

Dear Reviewer,

Thank you for reading our manuscript and reviewing it, which will help us improve it to better scientific level. We have made correction which we hope meet your approval. We improved epidemiological data to adjust it to international readers. No seasonal distribution in the procedures was found in the study group, which does not correspond with the study carried out by Chang-Hoon and Hyun-Hee. They revealed a clear seasonal variation, that demonstrated peaks every winter and summer during summer and winter breaks at schools in Korea. Our results may indicate strong determination to make a decision to undertake surgical treatment and awareness of the advantages of orthognathic treatment.
We changed the title to emphasize that the study was taken in Poland, we showed p in tables with statistical data and stressed values p<0,05.
We have sent revised manuscript and a version containing all the changes to be visible.

Yours Sincerely,

Authors

Round 2

Reviewer 3 Report

In my opinion the manuscript can be published in the present form