Search Results (37)

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

Background: Three-dimensional facial anthropometry is increasingly used in orthodontics and orthognathic surgery. Conventional face scanning systems such as Vectra^® and 3dMD^® are well validated but remain costly and technically demanding. The MetiSmile^® 3D face scanner provides a more affordable and portable alternative, yet its accuracy and reproducibility have not been rigorously evaluated. Methods: Validation was performed on a standardized mannequin head in two phases. Phase 1 assessed mesh reproducibility under artificial lighting (AL), natural lighting (n-AL), and after mesh-refinement (AL-F). Landmark-based pre-registration with Iterative Closest Point refinement was applied; root-mean-square error (RMS) and distance maps were calculated. In phase 2, three observers (student, resident, consultant) performed 14 predefined linear measurements by direct anthropometry (DA) and digital anthropometry (DiA). Intra- and inter-observer reliability was evaluated using intraclass correlation coefficients. Results: Phase 1 yielded mean RMS values of 0.041 mm (AL), 0.043 mm (n-AL), and 0.030 mm (AL-F), with largest deviations near eyes, alar regions, and lip commissures. Phase 2 showed excellent ICCs (≥0.997) and mean absolute DA–DiA differences of 0.25–0.33 mm, with only few differences > 2 mm. Conclusion: The MetiSmile^® scanner generates highly reproducible meshes and clinically acceptable linear measurements on mannequin models. Further validation on live subjects is warranted before routine clinical application. Full article

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce. Following PRISMA-ScR guidelines, a systematic search of PubMed, Scopus, Embase, and LILACS identified studies reporting facial implants placed concomitantly with orthognathic surgery. Eligible studies included case reports, case series, observational studies, clinical trials, and reviews involving human patients, without language or date restrictions. Seventeen studies published between 1998 and 2025 met the inclusion criteria, comprising retrospective and prospective designs, case series, and one technical note. Implants were used in the malar, infraorbital, paranasal, chin, mandibular body, and angle regions. Materials included PEEK, porous polyethylene, silicone, hydroxyapatite, polymethylmethacrylate, and titanium. PEEK was mainly used for patient-specific implants, while porous polyethylene was commonly used as stock implants. Follow-up time, outcome reporting, and study design varied widely, reflecting substantial methodological heterogeneity and predominantly observational evidence. As a result, outcomes were primarily reported qualitatively, limiting comparative assessment and long-term inference. Overall, the available literature suggests that alloplastic facial implants may serve as useful adjuncts to orthognathic surgery for contour enhancement, with outcomes influenced by implant design, surgical expertise, fixation, and soft tissue conditions. However, the current evidence base remains limited, underscoring the need for standardized outcome measures, comparative studies, and longer follow-up to better inform clinical decision-making and future research. Full article

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures. Full article

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear. Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions. Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level. Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation. Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique’s potential for both functional and aesthetic outcomes, warranting further long-term studies. Full article

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. The severe displacement of bone fragments, abnormal occlusion, comminution, and the involvement of multiple skeletal subsites further complicate the restoration of premorbid function and appearance. While previously recognized as a valuable tool for managing oncologic defects, orthognathic surgery, and for the correction of secondary deformities following maxillofacial trauma, virtual surgical planning (VSP) has now emerged as a viable tool for treating select patients following acute complex maxillofacial trauma. Methods: A retrospective chart review of all the complex facial trauma patients treated using VSP services over a 21-month period. Results: Multiple VSP services were used in the primary repair of complex facial trauma, with occlusal splints, pre-contoured plates, and 3D printed models being utilized most frequently. Conclusions: Our experience with VSP for primary maxillofacial trauma repair has helped us to identify specific indications for the use of VSP in this setting. Full article

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope of this paper. Full article

Study design: Systematic review. Objective: This systematic review examines the existing literature concerning the objective and subjective evaluations of osseous genioplasty outcomes. Methods: A comprehensive search was conducted in databases including PubMed, Embase, and Web of Science, yielding 2563 references, which were screened by two independent reviewers. We included 105 articles originating from 25 different countries. Data were systematically extracted, categorized, and documented. Results: Genioplasty was performed in 5218 patients, either independently (3560 cases) or in combination with other orthognathic procedures (1696 cases), with a predominant focus on female patients (64%). Objective evaluation primarily focused on surgical accuracy, relapse, and neurosensory disturbance, while subjective assessments were largely related to aesthetics and patient satisfaction. Despite significant advancements in three-dimensional surgical planning and assessment, the review highlights a lack of standardized methods for evaluating isolated genioplasty outcomes. Conclusions: The findings emphasize the need for improved and validated instruments that specifically assess the functional and aesthetic results of genioplastic surgery. Future research should prioritize patient-centered prospective studies and the development of assessment tools to ensure more comprehensive and reliable outcome evaluations. Full article

Study Design: Face and content validation of a surgical simulation model. Objective: Accidental transection of the inferior alveolar nerve (IAN) during bilateral sagittal split osteotomies (BSSO) has a reported incidence of up to 7%, determining important sensory disturbances in patients. Proper repair demands the need of microsurgical anastomosis skills. No previous training models have been described to simulate this. Therefore, we present a validated simulation model for intraoral repair of transected IAN. Methods: A CT scan of an orthognathic surgery patient was modified and a 3D model of a mandible with BSSO was printed. Chicken thigh anatomy was reviewed, and 2.5 mm sciatic nerves were dissected and mounted in the model. In order to simulate intraoral work depth, it was put inside a dental phantom or medical glove box. The model was tested by a group of experts (n = 12), simulating a transected IAN repair inside the mouth with both loupes and a double visor surgical training microscope. A survey was conducted to assess Face and Content validity. Results: The model was named RIANOS after Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator. The printing cost of each model was approximately US$3 and the design file is open-source and available for download. All experts “Strongly Agreed” that the model was useful for training inferior alveolar nerve microsurgical repair and would consider implementing it with their residents. Conclusions: We developed a low cost, reproducible, open-source simulator for IAN injury repair training during BSSO. Face and Content validity was achieved through evaluation by a group of experts. Full article

Study Design: Review of the literature with report of Case. Objective: To review the presentation of Actinomycosis specifically as it occurs with mandibular osteotomies. Methods: A review of the literature and report of an additional case. Results: While minor infections secondary to local factors are usually seen 2–3 weeks after surgery, late infections are rare. Host factors may play a role. When actinomycosis is diagnosed, long-term antibiotics are necessary. Conclusions: Actinomycosis is very rare following orthognathic surgery. It usually occurs in the mandible and following a sagittal split. Time of presentation for actinomycosis can vary from 6 weeks to 4 months as in our case. Infections occurring this late after surgery should be treated with suspicion of actinomycosis obtaining both cultures and tissue biopsies. Treatment involves an incision and drainage and long-term antibiotics. Full article

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in orthognathic surgery (OS) and their outcomes. Methods: Systematic reviews (SRs), randomized controlled trials (RCTs), and observational studies that evaluate perioperative OS co-interventions and surgical modalities will be identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature will also be screened. Results: Expected results include identification of all PICO questions available in the evidence regarding OS and generation of evidence bubble maps, involving a matrix of all identified co-interventions, surgical modalities, and outcomes presented in the studies. This will achieve identification of research gaps and prioritization of new research questions. Conclusions: The significance of this review will result in a systematic identification and characterization of the available evidence, leading to a reduction in research waste and a guidance of future efforts in developing studies for unsolved questions. Full article

Study Design: This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription- based database of over 40,000 state and federal records. Objective: There is growing academic interest in the medicalmalpractice literature. The primary objective of this study was to examinemedical malpractice in orthognathic procedures in order to characterize factors that determine legal responsibility and help make the craniomaxillofacial (CMF) surgeon more comfortable when treating this patient population. Methods: The database was queried for medical malpractice cases involving orthognathic surgery from 1985–2021. The characteristics of each lawsuit were identified, and descriptive statistics were reported. Results: A total of 42 CMF malpractice cases were available for review, and total of 15 cases were included in the final sample. Verdict decisions and settlements occurred between 1991 and 2012. Of the 15 cases, the highest concentration of cases occurred in California (6) and Pennsylvania (2). 53% of cases were ruled in favor of the defendant, 7% of cases were settled, 27% of cases were ruled in favor of the plaintiff against the surgeon, and 13% were ruled in favor of the plaintiff against the hospital with the surgeon being found not liable. The minimum award of damages was $29,999 and the maximum was $550,000. Conclusion: Litigation experience can be very time consuming and troublesome for medical practitioners. The risk of litigation and complications might be a prohibiting factor as to why CMF surgeons may not be preforming orthognathic surgery. The best defense against a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal. Full article

Study Design: This is a literature review with 3 case studies. Objective: Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to (1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, (2) identify management approaches, and (3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis. Methods: A literature search of PubMed was conducted and 28 cases from 17 studies were assessed. Results: Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases. Conclusions: As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability. Full article

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique. Full article

Study Design: The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-planned maxillary positioning by using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) splints combined with temporary mandibular fixation in bimaxillary orthognathic surgery. In orthognathic surgery, customized splints work sufficiently well to transfer preoperative planning into the operation site for transverse und sagittal positioning of the maxilla. The vertical positioning is more difficult due to the non-fixed mandibular reference. Therefore, the combined use of CAD/CAM splints and temporary mandibular fixation to the zygomatic region was applied for transferring the 3D-planned maxillary position into the operation site from 2012 until 2015 in our hospital. Objective: In addition to the general accuracy, the precision should therefore be checked especially in the vertical plane compared to axial and sagittal plane. Methods: In this retrospective study, we calculated the deviation of 5 occlusal landmarks of the maxilla in 35 consecutive patients by fusing preoperative 3D planning images and postoperative computed tomography scans after bimaxillary surgery. Results: The overall median deviation of maxillary positioning between plan and surgical result was 0.99 mm. The accuracy of left–right positioning was median 0.96 mm. Anterior–posterior positioning of the maxilla showed a median accuracy of 0.94 mm. Just slightly higher values were determined for the upward–downward positioning (median 1.06 mm). Conclusions: This demonstrates the predictability of maxillary positioning by using CAD/CAM splints in combination with temporary mandibular fixation in all 3 axes. Full article