Adaptation of soft tissue following bilateral sagittal split ramus osteotomy in skeletal class III patients with facial asymmetry: A retrospective study.

PURPOSE: This retrospective study aimed to evaluate sequential changes in soft tissue thickness after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients with facial asymmetry and to explore their correlation with surgical movements for optimal postoperative facial symmetry and esthetic outcomes. MATERIAL AND METHODS: This study included 37 patients with class III malocclusion and > 4 mm Menton (Me) deviation who underwent BSSRO. Posteroanterior cephalograms were captured at preoperative (T0), 6 weeks (T1), 6 months (T2), and 1 year (T3) postoperative intervals to analyze changes in Me deviation, fronto-ramal inclination (FRI), and soft tissue thickness. Statistical analysis was conducted to assess the changes in soft tissue thickness over time and the effects of surgical correction. RESULTS: Significant improvements in facial asymmetry were noted after surgery, with reductions in Me deviation and FRI on both the deviated side (DS) and non-deviated side (NDS). An increase in soft tissue thickness was observed on both the DS and NDS after surgery, with the NDS showing a continued increase between 6 months and 1 year, indicating an ongoing compensation for symmetry restoration. The study also identified a positive correlation between the surgical movement of the FRI and the increase in soft tissue width on the NDS after 6 months. CONCLUSION: This study established that soft tissue thickness continues to adapt and change up to 1 year after BSSRO, underscoring the need for a long-term evaluative approach in orthognathic surgery for patients with facial asymmetry.

Application of double layer with collagen-elastin matrix (Matriderm®) and polyglycolic acid sheet (Neoveil®) for oroantral and oronasal fistula closure after maxillectomy: a retrospective single center experience.

PURPOSE: This study investigates the effectiveness of a new double-layer approach for closing oroantral and oronasal fistulas (OA/ONFs) using Matriderm® and Neoveil®. Matriderm®, an acellular dermal matrix composed of collagen and elastin fibers, supports tissue regeneration, while Neoveil®, a biodegradable mesh sheet, serves as a barrier to prevent leakage and scarring. MATERIAL AND METHODS: A retrospective study of 12 maxillectomy patients with oral cancer between January 2022 and May 2023 was conducted. Patient data, including tumor stage, bone invasion, and defect size, were analyzed. Surgical techniques included sinus mucosa preservation, and either buccal fat grafting combined with the double layer technique or the double layer technique alone, with statistical analysis performed using R software to evaluate outcomes. RESULTS: The results indicate a 41.7% incidence rate of fistula formation with lower T stages, absence of bone invasion, smaller defect dimensions, and intact sinus mucosa correlating with reduced fistula risk (p < 0.05). Notably, no patients required fistula-related surgical revisions, validating the efficacy of the approach. CONCLUSION: This study introduced a novel double-layer technique using Matriderm® and Neoveil® for closing OA/ONFs after maxillectomy. The technique demonstrated promising outcomes in addressing these post-operative complications. Lower tumor stages, no bone invasion, smaller defects, and intact sinus mucosa correlated with reduced fistula risk. This technique holds potential to enhance maxillectomy outcomes, offering a comprehensive approach to functional concerns, but warrants further investigation.

Anatomical Characteristics of the Accessory Maxillary Ostium in Three-Dimensional Analysis.

Background and Objectives: The accessory maxillary ostium (AMO) can interfere with ventilation and drainage of the maxillary sinus, and therefore the importance of evaluating the anatomical features of the AMO has been emphasized. This study aimed to evaluate anatomical characteristics of the AMO together with the natural ostium (NO) using three-dimensional (3D) analysis and to assess the relationship between the AMO and maxillary sinus pathologies. Materials and Methods: This retrospective study included 394 sinuses in 197 patients. Using 3D computed tomography images, the prevalence of the AMO and concurrent sinus pathologies were examined. For patients with an AMO, 3D spatial positions of the AMO and NO related to adjacent anatomic structures and dimensions of the AMO and NO were evaluated. Results: A total of 84 sinuses showed single or multiple AMO, with a prevalence of 21.3%. The AMO was located superiorly by 30.1 mm from the maxillary sinus floor, inferiorly by 1.3 mm from the orbital floor, and posteriorly by 22.4 mm from the anterior sinus wall. The AMO was located 5.4 mm posteriorly and 0.7 mm inferiorly from the NO. On the same coronal plane as the NO or AMO, height from the maxillary sinus floor to the NO and AMO ranged from 19.4 to 45.8 mm and 14.5 mm to 41.9 mm, respectively. The mean horizontal and vertical dimensions were 5.9 mm and 4.6 mm for the NO and 2.8 mm and 3.0 mm for the AMO. We detected a significant association between the presence of the AMO and the mucosal thickening (p = 0.029). Conclusions: The results of this study suggest that, although the AMO and NO are mostly located in positions that do not limit sinus-related surgeries, such as maxillary sinus floor augmentation, the AMO and NO are also found in lower positions, which may be a detriment to the postoperative physiological function of the maxillary sinus and affect treatment outcomes.