Management strategies of pancreatic carcinoma in the era of systemic therapy: surgery first or surgery last / 中华消化外科杂志

Although the resection rate and surgical safety of pancreatic cancer has been significantly increased in recent years, however, the long-term prognosis of the patient remains dismal. In the era of multidisciplinary diagnosis and treatment, "surgery first", the traditional management strategy of pancreatic carcinoma, has been questioned and challenged because pancreatic carcinoma should be regarded as a systemic disease. For patients with locally advanced, borderline resectable or resectable tumors with high risks of recurrence, the option of "surgery last" should be advocated, which promotes systemic therapy. For patients with resectable tumors with better biological behaviors, the option of "surgery first" should be recommended.

Current status of the surgery-first approach (part I): concepts and orthodontic protocols / 대한악안면성형재건외과학회지

The “surgery-first” approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Surgery-first approach for Angle class Ⅲ malocclusion: clinical retrospective analysis of 185 cases / 中华整形外科杂志

Objective@#The purpose of this study was to explore the surgery-first approach in sequential combined orthodontic-orthognathic treatment to shorten total treatment duration and improve the clinical outcome.@*Methods@#This study included 185 patients with Angle classⅢ malocclusion. The patients were divided into 3 different types according to cephalometry analyses and facial features. ①Type Ⅰ: mandibular prognathism or asymmetry mandibular prognathism; ②Type Ⅱ: mandibular prognathism and maxillary retrusion; ③ Type Ⅲ: mild Angle′s Class Ⅲ malocclusion, cross bite in anterior teeth, or normal overlap and overbite relation with midfacial hypoplasia. All of patients received surgery first approach therapy. The surgical procedures were chosen according to different malformation types. Type Ⅰ was treated with the sagittal split ramus osteotomy (SSRO). Type Ⅱ was treated by Le Fort Ⅰmaxillary osteotomy combined with SSRO. Type Ⅲ underwent anterior subapical osteotomy combined pyriform aperture augmentation with biomaterials as well as maxillary anterior orthodontics. All patients received postoperative rapid orthodontic treatment for 6-12 month after 2 weeks of operation. Using the straight arch wire techniques and the class Ⅲ intermaxillary traction, we removed the overcrowding upper and lower teeth, the compensatory axial tilt of teeth, and the deviation of the dental arch and maintained the neutral relationship of the molar. The mandible Hawley retaining devices were used during the maintaining stage.@*Results@#The cases in study acquired satisfactory clinical outcome, which included the shortened overall treatment duration, the significantly improved facial features, the corrected occlusion relationship, and the restored function of mastication and temporomandibular joint. There were some complications as follows: intraoperative fracture (6 cases, 3.24%), the inferior alveolar nerve bundle injury (2 cases, 1.1%), and temporary open-bite that diminished by inter-maxillary elastic distraction one month after operation (19 cases, 10%). All cases in this study accepted postoperative orthodontic treatment. Follow-up time ranged from 6 months to 5 years. The cephalometric analysis results of 126 cases who had complete image data and over 6 months of follow-up showed that hard and soft tissue indexes were restored to normal range after combined orthognathic-orthodontic treatment. The stability of the maxillary and occlusive relationship of SFA(surgery-first approach) was similar to that of the COS(conventional orthodontics-first system) [relapse ratio=(T2-T1)/(T1-T0)×100%]. Over six months of follow-up , SNB and ANB showed that the average relapse ratio were 22% and 19.8%, whereas the relapse angle are less than 2°.@*Conclusions@#The Surgery-first approach could be used to treat most patients with Angle skeletal Class Ⅲ malocclusion, but the indications and the surgical procedures should be noticed and chosen.

Condylectomy and "surgery first" approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry

ABSTRACT Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

RESUMO A hiperplasia condilar (HC) é uma condição patológica autolimitante que produz deformidades faciais severas devido à assimetria mandibular. Nesse estudo de caso, uma paciente de 15 anos de idade foi diagnosticada com hiperplasia condilar unilateral (HCU), por meio de uma tomografia computadorizada por emissão de fóton único (SPECT) e de um estudo histológico. Uma condilectomia alta no côndilo direito foi realizada para interromper o status ativo da hiperplasia. Um mês após o procedimento, foram realizadas a impacção ortognática de maxilar e a cirurgia de retroposicionamento assimétrico da mandíbula, por meio de abordagem do tipo benefício antecipado. Depois de 10 dias, consultas ortodônticas passaram a ser feitas a cada duas semanas, durante 4 meses. A fase ativa do tratamento durou 14 meses. Excelentes resultados oclusais e faciais foram obtidos e, após 24 meses de contenção, os resultados permaneceram estáveis.

Qualitative correlation between postoperatively increased vertical dimension and mandibular position in skeletal class III using partial-least-square path modeling / 대한악안면성형재건외과학회지

BACKGROUND: This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA). METHODS: This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible. RESULTS: From PLS-PM, an increase in VD10 was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes. CONCLUSIONS: To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.

Clinical outcomes of surgery-first approach correcting adult skeletal class Ⅲ malocclusion / 中华医学美学美容杂志

Objective To explore the clinical effect of surgery-first approach (SFA) for correcting adult skeletal class Ⅲ malocclusion deformity patients.Methods A total of 28 adult patients diagnosed with skeletal class Ⅲ malocclusion were treated.Bilateral sagittal split ramus osteotomy (BSSRO) and geniplasty were performed without presurgical orthodontics treatment;postoperative orthodontics treatment was carried out after a healing period of 2-4 weeks.Lateral cephalometric radiographs were taken preoperatively (T1),within a week posoperatively (T2) and six months posoperatively (T3);cephalometric measurements were carried out by the software.Results All the patients were satisfied with the effect,no complications occured.The mean postoperative orthodontics treatment duration was 13.2 months.The mean setback of mandible at Po and B point was (7.74 ± 3.93) mm (P＜0.01) and (8.13±3.84) mm (P＜0.01),and superior movement lengths were (2.73±1.83) mm and (2.76±1.67) mm,respectively.Compared to T2,Po and B point moved forwardly with (2.36±1.23) mm and (2.66±1.65) mm,and inferior movment were (2.16±1.37) mm and (1.21±0.87) mm,respectively.The mean decrease of SNB and GA was (3.74± 1.61)° (P＜ 0.01),(3.41± 1.87)° (P＜0.01),respectively.During postoperative period,both of them increased,although these were no statistical differences.Conclusions SFA combined postoperative orthodontics therapy is feasible for the correction of adult skeletal class Ⅲ malocclusion,which has shorter treatment duration than traditional joint orthognathic-orthodontic.With the advantages of earlier improvements in patient's facial aesthetics and dental function,the reduction in difficulty and treatment duration of orthodontic management,and increasing patient acceptance.

Inclinación de incisivos maxilares en sujetos con deformidad facial de clase III: opciones en cirugía primero / Maxillary incisor inclination in subjects with class III facial deformity: options in surgery first

El objetivo de esta investigación es determinar la inclinación de incisivos maxilares en sujetos con maloclusión de clase III. Se incluyeron 35 sujetos que presentaran deformidad facial de clase III (DF-III) para analizar la tomografía computarizada de haz cónico; las mediciones se realizaron para los cuatro incisivos maxilares identificando el plano palatino considerado entre espina nasal anterior y posterior y el eje axial dentario obtenido por la unión entre punto coronal y punto apical; los resultados mostraron angulaciones de 111,6 a 113,7 para los incisivos, lo cual permite obtener valores cercanos a la normalidad de angulación dentaria. Se concluye que los sujetos seleccionados presentan una angulación dentaria adecuada para la realización de procedimientos de cirugía primero.

The objective of this research was to determine the inclination of maxillary incisors in subjects with class III malocclusion. Were included 35 subjects with Class III facial deformity (DF-III) to analyze cone beam computed tomography; measurements were realized in the four maxillary incisors identifying the palatal plane considered between anterior and posterior nasal spine and dental axial axis from the union between coronal point and apical point; The results showed angulations from 111.6 to 113.7 for the incisors, which allows estimation of values close to normal dental angulation. It is concluded that the selected subjects present adequate dental angulation to perform surgery first.

Surgery -First Approach in Orthognathic Surgery- A Case Report.

The surgery-first approach (SFA) or Surgery-first Orthognathic approach (SFOA) without pre-surgical orthodontic treatment, has become favoured in the treatment of dentomaxillofacial deformities. Conventional orthognathic surgery treatment involves orthodontic interventions both before and after orthognathic surgery, making the total treatment period of 3-4 years and temporary worsening of facial profile. Surgery-first approach involves orthognathic surgery being carried out first, followed by orthodontic treatment to align the teeth and occlusion and it takes the advantage of corticotomy- facilitated orthodontics allowing rapid tooth movement thus reducing treatment duration. The purpose of this article is to present a case of skeletal class III malocclusion treated with surgery-first approach with emphasis on selection of case, treatment protocol, indications, advantages and disadvantages of surgery-first approach.

Surgery-first approach using a three-dimensional virtual setup and surgical simulation for skeletal Class III correction / 대한치과교정학회지

A 19-year-old woman presented to our dental clinic with anterior crossbite and mandibular prognathism. She had a concave profile, long face, and Angle Class III molar relationship. She showed disharmony in the crowding of the maxillomandibular dentition and midline deviation. The diagnosis and treatment plan were established by a three-dimensional (3D) virtual setup and 3D surgical simulation, and a surgical wafer was produced using the stereolithography technique. No presurgical orthodontic treatment was performed. Using the surgery-first approach, Le Fort I maxillary osteotomy and mandibular bilateral intraoral vertical ramus osteotomy setback were carried out. Treatment was completed with postorthodontic treatment. Thus, symmetrical and balanced facial soft tissue and facial form as well as stabilized and well-balanced occlusion were achieved.

Paradigm Shift in Orthognathic Surgery: Surgery First Orthognathic Approach and Aesthetic Two-jaw Surgery

Orthognathic surgery became more popular because people are more interested in facial profile changes and are more receptive to surgery. As people seek beauty as well as function in maxillofacial surgery, patient's aesthetic demand becomes higher. Considering these big changes, one of the major reasons is surgery-first orthognathic approach(SFOA), which removes pre-surgical orthodontic treatment. Pre-surgical orthodontic time has been a great barrier to patients in terms of time and social rehabilitation. By SFOA, patients can get surgery as soon as they make up their mind; Patients from abroad can get surgery and get back to their country; They can go back to their work more easily because their occlusion is more acceptable. Surgery first orthognathic approach is still developing in practice and principle. However, as it is based on patient's need, it will play a greater part in the field of orthognathic surgery. Surgery first orthognathic approach together with aesthetic two jaw surgery are expected to change the paradigm in orthognathic surgery.