Rhinoplasty as an Adjunct to Orthognathic Surgery:: A Review.

Orthognathic surgery is a well-recognized method to correct dentofacial deformities. The main goal of orthognathic surgery is to improve soft tissue change. Soft tissue changes to the nose have been well documented. Simultaneous rhinoplasty during orthognathic surgery can be performed to correct existing inherent nasal deformities and also the unfavorable changes that arose from the maxillary surgery. Challenges for concurrent nasal surgery with jaw surgery include preoperative, perioperative, and postoperative which can be overcome with meticulous planning and experience. In complex cases, rhinoplasty can be staged in the last 6 months after the orthognathic surgery.

Esthetic Occipital Augmentation With Computer-Aided Design-Computer-Aided Manufacturing Prefabricated Customized Polymethyl Methacrylate Implant: Comparison of Planned and Final Results.

PURPOSE: Augmentation of the occiput is an esthetic procedure that is gaining more popularity but is not well reported in the literature. The aim of this retrospective study on a case series of patients was to describe the use of computer-aided design-computer-aided manufacturing prefabricated polymethyl methacrylate (PMMA) implants in esthetic occipital augmentation. Furthermore, comparison between the surgical outcome and the digital planning was carried out to ascertain the replicability of the surgical planning. MATERIALS AND METHODS: We performed a retrospective study of a case series of patients who underwent occipital augmentation with computer-aided design-computer-aided manufacturing prefabricated implants. Customized PMMA occipital implants were fabricated and were inserted via a bicoronal approach with patients under general anesthesia. The patients' 1-week postoperative cone-beam computed tomography image was superimposed onto the preoperative virtual planning images, and the positions of the actual implant and virtual implant were compared. RESULTS: A total of 15 patients who were treated at Charm Clinic, Taipei, Taiwan, and received occipital implants for esthetic purposes were included in this study. The percentage overlap of the occipital implant ranged from 87.8% to 99.99% (mean, 95.71%). One patient experienced partial wound dehiscence, which recovered after wound revision and suturing. In another patient, mild hematoma developed, which resolved spontaneously. Although no formal questionnaire was administered, all patients expressed satisfaction with the cosmetic outcome. CONCLUSIONS: The use of prefabricated PMMA posterior calvarial implants showed a rate of replicability of 87.8% to 99.99% (mean, 95.71%) compared with the preoperative virtual planning, and we recommend it as a feasible method for esthetic occipital augmentation.

Influence of Bimaxillary Surgery on Pharyngeal Airway in Class III Deformities and Effect on Sleep Apnea: A STOP-BANG Questionnaire and Cone-Beam Computed Tomography Study.

PURPOSE: To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume and the correlation of an obstructive sleep apnea (OSA) and hypopnea syndrome screening questionnaire (STOP-BANG) with various mandibular setbacks during bimaxillary surgery and compare these findings with an age- and gender-matched skeletal Class I control group. PATIENTS AND METHODS: This retrospective cohort study was composed of patients with skeletal Class III discrepancy who underwent bimaxillary jaw surgery and were assessed with STOP-BANG score, cephalometry, and cone-beam computed tomography (of the PAS). The predictor variable was bimaxillary jaw surgery and included 4-, 6-, and 8-mm setbacks. The primary outcome variables were PAS volume, body mass index, and STOP-BANG score evaluated at 1 week before surgery and after comprehensive orthodontic treatment (11.25 ± 1.95 months). Other variables were grouped into the following categories: demographic and cephalometric parameters. Statistical intragroup and intergroup differences were assessed by paired t and independent t tests (P < .05), respectively. RESULTS: The study sample was composed of 48 patients (18 to 25 yr old); group I received 4-mm setback (n = 16), group II received 6-mm setback (n = 16), and group III received 8-mm setback (n = 16) mandibular surgery, and all test groups received 4-mm maxillary advancement. The entire study group was compared with a skeletal Class I control group (n = 16). The total PAS volume after orthodontic treatment in groups I and II showed a significant decrease compared with the presurgical PAS (P < .001), but the decrease was not less than that in the control group (P > .05). In contrast, the total PAS volume in group III after orthodontic treatment (23,574 ± 1,394 mm3) was less than that in the control group (23,884 ± 1,543 mm3). CONCLUSION: After surgery, patients with Class III discrepancy exhibited a decrease in oropharynx volume; however, the STOP-BANG score showed no change in risk factors scores for OSA at 4- to 8-mm setback surgery of the mandible in bimaxillary jaw surgery.

Orthognathic patients with nasal deformities: case for simultaneous orthognathic surgery and rhinoplasty.

Orthognathic surgery is a recognised way of correcting dentofacial deformities and it is common practice to treat problems that affect the chin simultaneously, while deferring or not treating nasal deformities. There is inadequate published information about the prevalence of nasal deformities in such patients, and our aim was to remedy this. We retrospectively studied 75 patients with dentofacial deformities to find out if there was an association between nasal and dentofacial abnormalities. Forty-six of the 75 patients (61%) had mild to prominent cosmetic nasal problems, of whom 27 had deformities of the nasal bridge, 22 of the lobule of the nasal tip, 20 of nasal width, 14 in the width of the alar base, and 11 of the columella; 8 presented with deviation of the nose, and 6 with abnormal nasal length. Skeletal classes II and III had only slightly varied emphasis on nasal deformities. In comparison 14 patients (19%) had problems with the chin that required, or had already had, genioplasty. We also studied 9 patients who had had corrective bimaxillary surgery with simultaneous rhinoplasty. We set no formal questionnaire, but all patients expressed satisfaction with the postoperative results.

Lateral brow lift: how do I do it?

The lateral brow generally becomes ptotic earlier than the medial brow, and many techniques have been described to raise it. We describe a simple technique, which does not require expensive equipment such as an endoscope or fixation devices and reduces the risks that arise from large incisions and extensive dissection.

Incidence of second primary tumours in patients with squamous cell carcinoma of the tongue.

We retrospectively studied 329 patients with squamous cell carcinoma (SCC) of the tongue who were treated at The Chinese Academy of Medical Sciences, Peking Union Medical College, Department of Head and Neck Surgery of Cancer Hospital during the past 25 years (1975-2000). The patients were followed up for more than 36 months, and 28 (9%) developed 29 second primary carcinomas. The characteristics of the index tumour including the clinical appearance (10% nodular, 8% ulcerated), the site (10% anterior, 9% posterior, and 6% lateral), the classification (13% T1, 9% T2), the stage (12% stage I, 11% stage II, and 7% stage III), the histological appearance (7% well-differentiated, 14% moderately differentiated, 36% poorly differentiated, and 2% unknown), and the type of treatment given (18% resection only, 4% radiation only, and 6% combined treatment) were recorded. Twenty-three of the 29 second primary lesions developed in the upper aerodigestive tract with the oesophagus the most common site (79%). During the follow-up period, 14 patients died from causes associated with the second primary lesion and 5 from unrelated causes, and 9 patients were still alive at the time of follow-up. The prognosis for patients who develop second primary lesions is poor.

Retrospective study on the cutaneous head and neck melanoma in Dorset (UK).

Trends in the incidence and the sites of primary malignant melanoma on the skin of head and neck in Dorset as well as the outcome of treated cases were overviewed for the first time. Increase in incidence rate of cutaneous head and neck melanoma from 1.3 per 100,000 in 2004 to 3.1 per 100,000 in 2007 was recorded. The most prevalent histogenetic type of cutaneous malignant melanoma on head and neck in our study was melanoma of superficial spreading type 35.1% (n=20) of all registered cases. Superficial spreading melanoma apart from being the most common type of malignant melanoma of the head and neck in Dorset also showed increase in the number of diagnosed cases of the reviewed years. It increased from 2 (22.2%) of all head and neck melanoma cases in 2004 to 7 (30.4%) in 2007. The average age at the time of diagnosis the cutaneous malignant melanoma of head and neck for both men and women was 73.5 years. Breslow thickness, Clark's level of invasion, tumour ulceration and anatomical site remained the most important prognostic factors. Correlation between Breslow thickness and Clark's level of invasion found to be stronger in men.