Changes in occlusion after orthognathic surgery: a systematic review and meta-analysis.

PURPOSE: This study aims to systematically review and identify the changes of occlusion in patients after orthognathic surgery. METHODS: The protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42021253129. Studies included were Original articles only, Additionally, studies were included if the outcome of occlusal force was measured pre- and postoperatively and if occlusal forces resulted from a long follow-up of a minimum of 1 year following orthognathic surgery using adequate measurement tools. Non-English articles, case reports, case series, and non-original articles, including systematic reviews and literature reviews, were excluded. RESULTS: The search strategy yielded a total of 978 articles. Of the 978 articles, 285 were duplicates. After reading the titles and abstracts, 649 articles were excluded, and full-text articles of the remaining 47 studies were reviewed independently by two authors for eligibility wherein 33 articles were excluded, because they did not meet the inclusion criteria. Finally, a total of 14 studies were processed for critical review. CONCLUSION: The occlusal force increased after orthognathic surgery, although not to the level of the control group; however, the maximal bite force remained unchanged. Immediately after orthognathic surgery, chewing and swallowing forces increased. Significant reductions in the postoperative occlusal contact pressure areas was also observed.

An evidence-based surgical algorithm for management of odontogenic keratocyst.

The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy's solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003).

Minimally invasive genioplasty: an observational study.

PURPOSE: This study aimed to determine the feasibility of a minimal invasive genioplasty (MIG) technique combining a limited vertical incision, endoscopy, and a piezotome. METHODS: A total of thirteen patients who underwent primary genioplasty procedures under general anesthesia were evaluated. The feasibility of the method was reported in terms of total surgery time, the total amount of intra-operative blood loss, neurosensory dysfunction, pain sensation, infection, and patient satisfaction using the FACE-Q Chin scale. RESULTS: We observed the mean surgery time of 46.08 ± 5.33 min with a statistically significant p-value of 0.157. The ANOVA test value for mean neurosensory testing score (NST) was calculated as 5.95 (p = 0.006) for the right side and 7.64 (p = 0.017) for the left side. The paired t-test value of the mean pain score was 117.98 (p < 0.001) and showed no significant pain after 1 week. The quality of the osteotomy was deemed good in 12 patients with less intra-operative blood (ranged from 7.7 to 46.2%). CONCLUSION: Based on these results, this minimally invasive technique for genioplasty is a promising approach to perform a chin osteotomy and should be an alternative to the conventional genioplasty technique.

A Case Report on Surgical-Orthodontic Correction of Skeletal Class III Malocclusion with Severe Prognathic Mandible and Retrognathic Maxilla.

Mandibular prognathism combined with a retrognathic maxilla is a skeletal discrepancy that is difficult to correct. We report a case of a 25-year-old Saudi male patient with skeletal class-III malocclusion due to severe prognathic mandible who was referred to an orthodontist at Prince Sultan Military Medical City. Complete clinical examination, radiographic assessment, and study models revealed class-III malocclusion due to anteroposterior deficiency of the maxilla and severe prognathic mandible. Orthognathic surgery was performed 18 months after the presurgical orthodontic phase. A 10-mm LeFort I advancement of the maxillary arch, with impaction of 3 mm, was performed with a bilateral sagittal split osteotomy (BSSO) of 11 mm. Stable occlusion and superior aesthetics were observed at the 1-year follow-up. Surgical-orthodontic treatment endows an adult patient with a class-III malocclusion or mandibular prognathism with a stable occlusion and superior aesthetics.

Does Intraoperative Computed Tomography Scanning in Maxillofacial Trauma Surgery Affect the Revision Rate?

PURPOSE: The purpose of this study was to determine how intraoperative computed tomography affects the intraoperative revision rate and consequently the post-operative, secondary corrective surgery in maxillofacial trauma surgeries. PATIENTS AND METHODS: A retrospective study composed of patients with facial fractures was conducted in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. The predictor variables were age, gender, site of facial fracture, type of treatment, number of scans per patient, and discharge time. The primary outcome variable was immediate intraoperative revision rate. Secondary outcome variable was total scanning time (recorded from the moment surgery was halted until it was resumed after image acquisition). Descriptive statistics were used; numerical data presented as mean ± SD and categorical variables as frequency (%). RESULTS: A total of 22 patients underwent 25 intraoperative scans while undergoing different maxillofacial surgeries. Eleven (50%) required intraoperative revisions after the scans, and 3 (13.6%) cases had another intraoperative scan after revision. Eighteen were men and 4 were women. The mean age was 30 years and age range was 19 to 76. Cases were categorized by fracture location and treatment preformed. The mean scanning time was 18.9 ± 4.6 minutes. The highest rate of revisions was seen in zygomaticomaxillary complex fractures (63.6%), they were also the only cases that required a second intraoperative scan after revision to confirm final reduction. No complications were seen postoperatively, and all patients recovered uneventfully. None of the patients required a secondary corrective surgery. All patients were discharged on the following day, except 1 case which was admitted under another service. CONCLUSIONS: The use of intraoperative computed tomography imaging in treating maxillofacial fractures results in a higher rate of intraoperative revisions, which in turn leads to more accurate fracture reduction and consequently reduces the possibility of a postoperative, secondary corrective surgery.

Patient-specific implants for maxillofacial defects: challenges and solutions.

BACKGROUND: Reconstructing maxillofacial defects is quite challenging for most surgeons due to the region's complex anatomy and cosmetic and functional effects on patients. The use of pre-made alloplastic implants and autogenous grafts is often associated with resorption, infection, and displacement. Recent technological advances have led to the use of custom computer-designed patient-specific implants (PSIs) in reconstructive surgery. This study describes our experience with PSI, details the complications we faced, how to overcome them, and finally, evaluates patient satisfaction. CASE PRESENTATION: Six patients underwent reconstruction of various maxillofacial defects arising due to different etiologies using PSI. A combined total of 10 implants was used. PEEK was used to fabricate 8, while titanium was used to fabricate 2. No complications were seen in any patient both immediately post-op and in subsequent follow-ups. All patients reported a high level of satisfaction with the final result both functionally and cosmetically. CONCLUSION: The use of computer-designed PSI enables a more accurate reconstruction of maxillofacial defects, eliminating the usual complications seen in preformed implants and resulting in higher patient satisfaction. Its main drawback is its high cost.

Comment on: An analysis of the first and second mandibular molar roots proximity to the inferior alveolar canal and cortical plates using cone beam computed tomography among the Saudi population.

[No Abstract Available].

Facial fistula. Long-term sequelae of a complicated exodontia.

Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with dermatological infection, and hence, mistreated. We report a case of facial fistula that developed 8 years following a dental extraction, presenting its clinical appearance, radiographical findings, and treatment approach.