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To compare lower lip changes after Le Fort I advancement surgery in patients with a cleft., Single institution, retrospective review., Academic tertiary referral hospital., Skeletally mature patients with a cleft who underwent one-piece Le Fort I advancement surgery who had a lateral cephalogram or cone-beam computed tomography (CBCT) scan preoperatively and at least 6 months postoperatively. Patients who underwent concomitant mandibular surgery or genioplasty were excluded. 64 patients were included: 45 male and 19 female, 25 with BCLP and 39 with UCLP. The mean age at surgery was 18.4 years., Single jaw one-piece Le Fort I advancement surgery., Standard lateral cephalometric landmarks of the bony skeleton and soft tissue were compared before and after Le Fort I advancement. Pearson correlation coefficients (r) were calculated to measure the correlation between lower lip position and other soft and hard tissue changes., After comparable maxillary advancements [BCLP: 7.2 mm (95% CI: 6.2-8.3 mm), UCLP: 6.4 mm (95% CI: 5.7-7.0 mm)] the horizontal upper-to-lower lip discrepancy significantly improved in both groups. The lower lip became thinner and more posteriorly positioned. Changes in lower lip position correlated strongly with mandibular bony landmarks and moderately with upper lip position, but poorly with maxillary landmarks., Le Fort I advancement results in posterior displacement of the lower lip and better lip competence, thereby improving facial harmony. This lower lip change is not predictable by degree of maxillary advancement, and does not differ in patients with BCLP vs. UCLP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: It is necessary to determine whether the sequence of maxillary and mandibular surgeries in bimaxillary orthognathic surgery affects the accuracy of surgical outcomes., Purpose: The study aimed to measure and compare the accuracy among patients who underwent maxilla-first versus mandible-first bimaxillary surgery to correct a class III skeletal pattern., Study Design, Setting, Sample: This retrospective cohort study included consecutive patients treated by a single surgeon at one center using Le Fort I and bilateral sagittal split osteotomy surgery. Exclusions included patients scheduled for one-jaw or maxilla-segmental surgery and those with craniofacial syndromes, such as clefts., Predictor Variable: The predictor variable was operative sequence for bimaxillary operations, divided into maxilla- or mandible-first groups., Outcome Variable: The outcome variable was accuracy, measured using linear discrepancies between landmarks in the virtual plan and actual operative outcomes. The measurement of linear discrepancy that was closer to 0 was considered the more accurate result., Covariates: Sex, age, maxilla sagittal rotation degree, amount of posterior maxilla impaction, mandibular autorotation (°), and intermediate splint thickness (mm) were the covariates., Analyses: Statistical analysis was performed using Student's t-test and Pearson's correlation, with statistical significance set at P < .05., Results: The sample comprised 60 patients with a mean age of 22.8 ± 3.7 years, of whom 36 (60%) were male. In the maxilla-first group, there were 30 subjects (60% male; mean age: 23.1 ± 4.2 years), with a mean mandibular autorotation of 0.41° (range: 0°-2.5°). The mandible-first group comprised 30 patients (60% male; mean age: 22.6 ± 3.3 years), with a mean mandibular autorotation of 5.46° (range: 1.9°-9.2°). The linear discrepancies for all landmarks did not significantly differ between mandible- and maxilla-first groups (P > .18). The mean three-dimensional discrepancies for all landmarks in maxilla-first group was 1.23 ± 0.5 mm and 1.23 ± 0.33 mm in mandible-first group, with no significant difference observed between the groups (P > .98). The amount of mandibular autorotation for intermediate splint application showed no significant correlation with the linear discrepancies (P > .58)., Conclusion and Relevance: In patients with skeletal class III malocclusion, mandible-first surgery in bimaxillary orthognathic surgery demonstrates accurate outcomes comparable to maxilla-first surgery., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: PEMF (pulsed electromagnetic fields) founds application in several medical fields to accelerate bone wounds healing and to reduce inflammation. The aim of our study was to evaluate the effectiveness of PEMF in reducing postoperative swelling and pain in patients undergoing orthognathic surgery., Methods: A prospective observational monocentric study was conducted on a sample of 30 patients undergone to orthognathic surgery in Maxillofacial Surgery Unit of University of Naples Federico II. The patients who followed these inclusion criteria were enrolled in the study: age ≥ 18 years, Class III malocclusion, Surgical procedure of Le Fort I osteotomy + Bilateral Sagittal Split Osteotomy (BSSO), Written informed consent. Patients were divided into two groups: Group SD) postoperative standard treatment with medical therapy and cryotherapy, Group SD + PEMF) postoperative standard therapy + PEMF. Each patient underwent a 3D facial scan, at one (1d) and four (4d) days after surgery to compare the swelling reduction. The pain score was assessed through VAS score and analgesics administration amount., Results: In SD + PEMF group, the facial volume reduction between 1d and 4d scan was on average 56.2 ml (6.23%), while in SD group, it was 23.6 ml (2.63%). The difference between the two groups was 3.6% (p = 0.0168). VAS pain values were significantly higher in SD group compared to SD + PEMF group in the second day after surgery (P = 0.021) and in the total 4 days (P = 0.008)., Conclusions: Our data suggest that PEMF is valid tool to promote faster postoperative swelling and pain reduction in patients undergoing orthognathic surgery., (© 2024. The Author(s).)

Purpose: To objectively evaluate the effect of maxillary advancement on speech and VPI using video-fluoroscopy (VFS), direct nasoendoscopy, and speech evaluation and subjectively assess patients and their peer's perception regarding their speech outcome., Materials and Methods: 27 cleft patients who underwent Lefort 1 maxillary advancement were divided into 2 groups- Group A with 4-7 mm of advancement and Group B with 8-13 mm advancement. VFS in lateral view, nasoendoscopy, and speech recordings were performed pre and 6 months postoperatively. VFS assessed the relative position of velum in relation to the pharyngeal wall, speech was evaluated for changes in nasal emission, resonance, and articulation along with nasal endoscopy to assess the overall function of the velopharyngeal valve. Subjective speech evaluation was done with a Patient-Reported Outcome Measure [PROM] questionnaire., Results: As per VFS, for every 1 mm maxillary advancement, the velopharyngeal gap at rest increased by 1.75 mm in group A and 1.58 mm in group B. The compensatory changes in group B were more pronounced. Post-operative VFS showed velar closure remained the same as preoperative closure in 86.7%, and worsened in 13.3% in group A whereas it remained unchanged in 66.7%, improved in 25%, and worsened in 8.3% in group B. In nasoendoscopy, the closure pattern showed no change in 86.6%, improved in 6.7%, and deteriorated in 8.3% in group A while there was no change in 83.4%, improved in 8.3%, and deteriorated in 8.3% in group B. Dental and labiodental articulation statistically improved [p < 0.05] after surgery. PROM reported 85.7% of patients with improved speech, 82.1% improved sound quality along with 89.3% improvement in articulation., Conclusion: The primary cause for functional impairment and poor aesthetics in cleft deformity is the maxillary hypoplasia and therefore, should be the focus during correction. The pre-operative VP status or the amount of maxillary advancement could not predict the postoperative VP status. Maxillary advancement over 10 mm did not seem to significantly affect the final VP status. Articulation improves due to increased tongue space and favorable dental segment positioning. Mild to moderate immediate post op changes in nasality improves or even reverts to their preoperative status in the majority of the cases in about six months., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Perioperative bleeding is a serious concern during orthognathic surgery. Tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic properties, reduces blood loss across various surgical fields. This study aimed to investigate the effectiveness of preoperative TXA administration in reducing intraoperative and postoperative blood loss following combined Le Fort I and sagittal split ramus osteotomies at our hospital., Methods: This single-center, retrospective cohort study included patients who underwent combined Le Fort I and sagittal split ramus osteotomies between November 2017 and October 2022. The primary outcome was the volume of intraoperative blood loss., Results: Among 1,329 eligible patients, 87 were included in the analysis (32 in the TXA group and 55 in the control group, where no TXA was administered). The median (interquartile range) intraoperative blood loss was 200.0 (157.5-237.5) mL in the TXA group and 260.0 (180.0-350.0) mL in the control group, showing a significant difference between the groups (p = 0.0365). However, postoperative blood drainage within 24 h and 24-48 h did not differ significantly between the two groups., Conclusion: A single intravenous administration of TXA was associated with a decrease in intraoperative bleeding without severe adverse events during combined Le Fort I and sagittal split ramus osteotomies. However, postoperative blood loss, nausea, vomiting, and autologous blood transfusion were not significantly associated with this administration., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This retrospective study examined long-term (4-5 years) condylar positional and volumetric changes and skeletal stability after bimaxillary orthognathic surgery in skeletal Class III patients. Pre-surgical (T0: 0.9 ± 1.1 months) and post-surgical (T1: 0.6 ± 0.7 months; T2: 12.8 ± 3.1 months; T3: 56.5 ± 6.5 months) cone beam computed tomography (CBCT) images of 22 patients were obtained. CBCT multiplanar reformation (MPR) images were generated, and three-dimensional (3D) condylar models were constructed and superimposed to compare changes in condylar volume from pre- to postoperative. Condylar position in the sagittal and coronal planes altered immediately after surgery; however at long-term follow-up, the condyles had returned to their pre-surgical position. The condyles remained slightly inwardly rotated at short-term (-2.6°, 95% confidence interval -3.5° to -1.7°) and long-term (-1.9°, 95% confidence interval -2.8° to -1.0°) follow-up. Changes in condylar volume were insignificant after surgery. Condylar positional changes had no effect on skeletal stability. However, patients with an increased face height prior to surgery and more retrusive jaw position postoperatively were more prone to condylar resorption. Surgical changes remained stable 4-5 years after surgery. In conclusion, condylar position changed insignificantly following surgical correction in Class III patients provided that the correct surgical technique was employed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In combined orthodontic-orthognathic treatment, the maxillary palatine suture is closed in most patients with insufficient maxillary width, and bony expansion of the maxilla cannot be achieved by dental expansion or rapid palatal expansion (RPE) which causes buccal inclination of the maxillary posterior teeth leading to unstable results. Therefore, segmental LeFort Ⅰ osteotomy and surgically assisted RPE are often used in clinical practice. In recent years, with the application of implant anchorage technology, implant anchorage assisted RPE has been gradually applied in orthognathic treatment. This article reviewed the indications, contraindications, complications, efficacy and long-term stability in different treatment approaches including segmental LeFort Ⅰ osteotomy, surgically assisted RPE and implant-supported maxillary skeletal expansion.

The titanium osteosynthesis system used for fixing bone segments after maxillary osteotomy provides reliable outcomes owing to its biocompatibility and adequate strength. In addition, several studies have evaluated the skeletal stability after maxillary osteotomy with fixation using a biodegradable system. However, the indications for applying a biodegradable system after maxillary osteotomy remain controversial. Therefore, this study aimed to compare the long-term skeletal stability of bone segments after maxillary osteotomy with bone fixation using biodegradable and titanium osteosynthesis systems and to assess the usefulness of a biodegradable osteosynthesis system. Patients who underwent Le Fort I osteotomy of the maxilla to correct jaw deformities between April 2008 and March 2021 were included in this study. A total of 45 patients were included, with 28 in the biodegradable osteosynthesis system group and 17 in the titanium group. Cephalometric and computed tomography analyses were performed to evaluate the skeletal stability of the bone segments after maxillary osteotomy with bone fixation using biodegradable or titanium osteosynthesis systems. The maxillary segment was repositioned anteriorly with a clockwise rotation. Skeletal stability was similar between the biodegradable and titanium osteosynthesis systems. Segmental changes occurred mainly in the first 6 months after surgery, and the segment was completely stable between 6 and 12 months after surgery. This study revealed no significant differences in skeletal stability after maxillary osteotomy between the biodegradable and titanium osteosynthesis systems. However, the findings in this study should be interpreted with caution owing to the small sample size and small amount of maxillary-segment movement., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Among the accuracy analysis techniques for orthognathic surgery, regional voxel-based registration (R-VBR) has robust data, but remains unvalidated for smaller jaw segments. The purpose of this study was to validate the angular accuracy of R-VBR for segmental Le Fort I (SLFI) and genioplasty osteotomies. Postoperative cone beam computed tomography (CBCT) of consecutive patients with three-piece SLFI or genioplasties was rotated to a known pitch/roll/yaw (P/R/Y). Using R-VBR, a copy of the raw CBCT was superimposed onto the rotated CBCT at four mutual regions of interest (ROI): anterior, right posterior, and left posterior maxilla, and chin. The P/R/Y of each was subtracted from those of the rotated CBCT to calculate the angular error. The predictor and outcome variables were ROI and absolute angular error, respectively. The accuracy threshold was 0.5°. Ten SLFI and 34 genioplasties were analyzed based on the sample size calculation. The one-sample t-test and Wilcoxon signed rank test were applied in the analysis. The mean absolute error was 0.20-0.54° for the maxillary segments (all P ≤ 0.01) and 0.83-2.51° for the genioplasty segments (all P < 0.001). R-VBR has variable angular accuracy for SLFI osteotomies and may be insufficient for genioplasty. The findings may allow the design and interpretation of studies on SLFI and genioplasty with greater rigor, thereby contributing to minimizing the discrepancy between planned and achieved outcomes., (Copyright © 2023 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the efficiency of segmental Le Fort I osteotomy in clear aligner therapy of skeletal Class III deformities and to explore whether Le Fort I segmental osteotomy was effective for maxillary incisor axis correction and reduced the duration of perioperative orthodontics., Materials and Methods: Patients who had skeletal Class III deformities (ANB<0) treated with extraction of the maxillary first premolars, segmental Le Fort I osteotomy, and clear aligners therapy were included in this retrospective study. We measured the amount of tooth extraction space that was closed by surgery and recorded the preoperative orthodontic and total treatment duration. Lateral cephalograms were analyzed to measure changes of maxillary incisor inclination before treatment (T0), 1 week before surgery (T1), 1 week after surgery (T2), and after total orthodontic treatment (T3). Statistical analyses were performed, and the P value was set at 0.05., Results: The sample was composed of 15 patients aged 19 to 30 (M=22.9) years. The average preoperative orthodontic treatment duration was 16.2±5.22 mo, with 33.5 pairs of clear aligners. The gap at the extraction site decreased from 5.42±1.57 mm to 0.80±0.62 mm on average after surgery. U1-SN and U1-NA(deg) increased sparingly with preoperative decompensation, decreased in quantity after surgery, and then slightly increased with postoperative compensation (T20.05)., Conclusions: Le Fort I segmental osteotomy assisted decompensation of the upper anterior teeth and reduced the duration of preoperative orthodontics with clear aligners., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

This study aimed to evaluate maxillary bone healing and computed tomography (CT) values after Le Fort I osteotomy with sagittal split ramus osteotomy in patients with class II and III malocclusion. Four absorbable plates and screws were used to fix the maxillary segments in all patients. For 112 sides (58 patients), the bone defect areas at the anterior and posterior sites between the maxillary segments were measured using 3-dimensional CT views reconstructed over a constant CT value at 1 week and 1 year postoperatively. Subsequently, CT values at the upper, middle, and lower sites around the osteotomy line in the medial, middle, and lateral regions were measured. The bone defect area after 1 year increased at the anterior site in class III and at both the anterior and posterior sites in class II (P < 0.05). This study suggests that the increase in bone defect area was affected by lower CT values at the middle site of the middle and lateral regions in class II, and that bony defects between fragments in the maxilla could partially remain in both classes II and III within 1 year after Le Fort I osteotomy., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO., Materials and Methods: This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions., Results: A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups., Conclusion: The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Introduction: Orthognathic surgery has the potential to compromise the vitality of the teeth. This paper aims to assess changes in pulp blood flow (PBF) and pulp sensibility (PS) of the anterior dentition following orthognathic surgery and to assess the influence of the proximity of the surgical osteotomy on the PBF and/or PS., Methods: Twenty-six patients undergoing orthognathic surgery (Le Fort I or bilateral sagittal split osteotomy [BSSO]) were compared to sixteen control patients treated by fixed appliances only using Laser Doppler flowmeter (LDF) and thermal testing (CO2 snow). Surgery patients were tested at T1 (presurgery), T2 (4-5 weeks postsurgery), T3 (3 months postsurgery), and T4 (6 months postsurgery). Control patients were tested at T1 (pretreatment), T2 (6 months posttreatment), T3 (12 months posttreatment), and T4 (18 months posttreatment). Differences between the maxilla and mandible were assessed., Results: No differences in PBF or PS were recorded in the control group. In the surgery group, both jaws followed the same pattern after surgery, an initial decrease at T2 followed by a gradual recovery to pretreatment PBF levels with no significant difference between T1 versus T4 in both jaws. No difference in PBF was observed between the maxilla and mandible at any testing time interval., Conclusions and Clinical Implications: PBF and PS of the anterior dentition was severely affected immediately postsurgery, followed by a gradual increase to full recovery. This pattern of recovery was exhibited in both jaws. A negative sensibility response or discoloration should not be seen as an indication of irreversible ischemic pulp changes. Monitoring for at least 6 months or using LDF as a confirmatory test is required before any irreversible endodontic treatment is to be considered., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

In this study we compared the aesthetic outcome of (1) Le Fort I (LFI) osteotomy and (2) intraoral quadrangular Le Fort II (IQLFII) osteotomy for surgical correction of skeletal class III dysgnathia involving midfacial deficiency. The aim was to investigate whether laypersons see differences in facial changes that occur due to variations of the osteotomy cuts. The patient collectives consisted of 23 patients in each group. Pre- and postoperative photographs were presented in a random sequence to 40 layperson raters. The rating procedure was conducted with a four-point Likert scale. Assessed characteristics were 'attractiveness' ('Attraktivität'), 'likeability' ('Sympathie'), 'intelligence' ('Intelligenz'), 'aggressiveness' ('Aggressivität') and 'dominance' ('Dominanz'). For preoperative photographs we found a significant difference for 'likeability' with lower ratings for the IQLFII group; all other criteria were rated similarly. For the IQLFII group we found a significantly larger shift from lower to higher ratings for 'attractiveness' and 'likeability' and a significantly larger shift from higher to lower ratings for 'aggressiveness' and 'dominance' than for the LF I group. Our study shows that lay raters detect significant differences between the two surgical groups. Thus, IQLFII osteotomy, when indicated, represents a favourable alternative to conventional LFI osteotomy, if patients desire the expectable change in recognition by their social circle. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed (1) to evaluate the site and severity of facial asymmetry in Class III patients before and after bimaxillary surgery, and (2) to identify the influence of initial severity and positional jaw asymmetry on residual facial asymmetry., Materials and Methods: Preoperative and postoperative cone-beam computed tomography of 65 patients with Class III facial asymmetry who underwent bimaxillary surgery were evaluated. Five midline and 14 paramedian facial soft tissue landmarks were identified to assess facial asymmetry. The outcomes were compared to a control group consisting of 30 age- and gender-matched Class I subjects. The postoperative positional jaw asymmetry (i.e., shift, roll, yaw) of each osteotomy segment (maxilla, mandible, chin, ramus) was also measured., Results: Before surgery, the asymmetry was more severe at the chin, middle and lower contour. Bimaxillary surgery effectively corrected facial asymmetry, particularly in achieving normalization of chin deviation. However, significant asymmetry persisted postoperatively in the middle and lower contour (p < 0.001 and p < 0.01, respectively), which was affected by the positional ramus asymmetry in the roll and shift., Conclusions: Deviation of the chin, middle and lower contour contributed significantly to overall facial asymmetry in Class III asymmetry. Despite normalization of the chin deviation after bimaxillary surgery, asymmetry persisted at the middle and lower contour, primarily as the result of insufficient correction of the positional ramus asymmetry., Clinical Relevance: Understanding the residual asymmetry after bimaxillary surgery is important for minimizing deviation and optimizing the surgical planning for its correction., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery., Methods: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066)., Results: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition., Conclusion: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications., (© 2024. The Author(s).)

Orthognathic surgery may induce hemorrhage resulting from nasal mucosal injury or from maxillary osteotomy sites, and if severe, the hemorrhage may cause airway obstruction. The patient in this case report was a 27-year-old woman who underwent Le Fort I and bilateral sagittal split osteotomies under general anesthesia. There were no abnormal intraoperative vital signs. However, immediately after the patient was returned to the ward, significant bleeding that required frequent suctioning was observed in the oral cavity. As the bleeding persisted, the surgeon attempted to insert epinephrine-soaked gauze and polyvinyl acetal sponges into both nasal cavities, but hemostasis was difficult to obtain. To achieve hemostasis by compression/closure at the choana and maintain nasal patency, we inserted a modified cuffed endotracheal tube to serve as a transnasal airway and a choanal hemostatic balloon. This method resulted in hemostasis. The volume of blood loss after returning to the ward was approximately 420 mL. The transnasal airway and choanal balloon was useful for airway management and the prevention of intranasal bleeding into the lower pharyngeal regions. Furthermore, the method was simple and minimally invasive, suggesting its clinical usefulness in similar situations.

The aim of this study was to investigate the impact of bimaxillary orthognathic surgery on patients' anthropometric measures and laboratory parameters. This study was conducted on patients who underwent bimaxillary orthognathic surgery. Anthropometric measurements were collected before surgery (T0) and at intervals of one week (T1), two weeks (T2), one month (T3), and three months (T4) postoperatively, and laboratory parameters at T0 and T4. Data analysis included repeated-measures ANOVA for assessing weight changes, body mass index (BMI) and fat percentage changes, the Friedman test for muscle mass changes, and independent t tests to understand gender-based differences. Significant reductions were observed in weight (mean differences ranging from 2.26 kg to 3.84 kg, 95.00% CI: 1.29 to 4.62, p < 0.01) and BMI (mean differences ranging from 0.76 to 1.32, 95.00% CI: 0.38 to 1.58, p < 0.01) postoperatively at all follow-up points. Fat percentage changes were significant between T0 - T3 (MD = 1.17, 95.00% CI: 0.26 to 2.08, p < 0.05) and T0 - T4 (MD = 1.28, 95.00% CI: 0.14 to 2.43, p < 0.05). Changes in muscle mass were significant until T3 (MD ranging from 71.00 to 107.0, p < 0.01). Also, haemoglobin levels were significantly higher at T0 than T4 (MD = 0.35, 95% CI: 0 to 0.7). These changes showed no significant gender-based differences (p > 0.05). Our study showed that orthognathic surgery prompts temporary changes in body weight, Body Mass Index, and haemoglobin levels. Future research should explore interventions to mitigate these changes and enhance postoperative recovery., (Copyright © 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation., Materials and Methods: Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups., Results: There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05)., Conclusion: Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions., Clinical Relevance: Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly., The Trial Registration Number (trn): NCT06103422/Date of registration: 10.17.2023 (retrospectively registered)., (© 2024. The Author(s).)

The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion., (© 2024. The Author(s).)

Orthognathic surgery typically relies on the rigid fixation of fracture fragments using metal hardware. Though hardware is usually intended to be implanted permanently, the removal of hardware (ROH) is sometimes indicated for a variety of reasons. The authors sought to identify risk factors for ROH following orthognathic surgery. The authors conducted a retrospective analysis of the Merative MarketScan Research Databases, 2007-2021 using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and ICD-10) codes to identify patients who underwent an index Le Fort 1 osteotomy and bilateral sagittal split osteotomy operation on the same day. Statistical analysis involved χ 2 , Shapiro-Wilk, Wilcoxon-Mann-Whitney, Poisson regression, and multivariable logistic regression tests. 4698 patients met the inclusion criteria. The mean age at surgery was 25 years, and 57% were female. ROH occurred in 5.9% of patients. The mean time to hardware removal was 190.5±172.4 days. In a multivariate logistic regression, increased odds of ROH were associated with older patient age [OR: 1.02 (1.01-1.03), P =0.046], sleep apnea [OR: 1.62 (1.13-2.32), P =0.018], and craniofacial syndrome and/or cleft diagnoses [OR: 1.88 (1.14-2.55), P <0.001]. In the same model, postoperative oral antibiotic prophylaxis was not associated with ROH ( P =0.494). The incidence of all-cause complications [IRR: 1.03 (1.01-1.05), P <0.001] rose over the study period, while the incidence of ROH did not change significantly ( P =0.281). Patients at elevated risk should be counseled on the increased possibility of a second operation for ROH before having orthognathic surgery to ensure expectations and health care utilization decisions align with the evidence., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Introduction: Effective pain management is crucial in cleft lip and palate (CLP) patients undergoing orthognathic surgery for earlier recovery and decreased opioid reliance. Liposomal bupivacaine (Exparel) is a local anesthetic that provides extended postoperative analgesia in adult patients; however, research on its use in adolescents is limited. This study explores the efficacy of liposomal bupivacaine for postoperative pain management in adolescent CLP patients undergoing orthognathic surgery., Methods: The authors performed a retrospective chart review at their institution between July 2020 and December 2022 to identify patients who underwent LeFort I or mandibular osteotomy. Two cohorts were compared: patients who received liposomal bupivacaine and patients who received standard pain medications alone. Outcome measures included intraoperative pain medications, length of stay, breakthrough opioid use, time to first oral intake, volume of oral intake, and opioids prescribed at discharge., Results: This study included 22 patients who underwent orthognathic surgery. The liposomal bupivacaine group (n=10) demonstrated earlier and greater oral intake during hospitalization compared with controls (n=12). The most significant difference was observed in total breakthrough opioid use, with an average of 8.60 morphine milligram equivalents for liposomal bupivacaine patients compared with 35.1 morphine milligram equivalents for controls ( P =0.037)., Conclusions: This study provides the first analysis of liposomal bupivacaine use in adolescent CLP patients undergoing orthognathic surgery, demonstrating a significant reduction in postoperative opioid consumption compared with controls. These results may guide future studies of liposomal bupivacaine within CLP patients, potentially as a component of enhanced recovery after surgery guidelines, as well as in cost-analysis studies., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Purpose: This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery., Methods: The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed., Results: The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements., Conclusion: This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: This study was designed to investigate the changes in nasal soft tissue following maxillary Lefort I advancement with and without impaction in subjects presenting a skeletal class III malocclusion, using a 3D photogrammetry scanner., Materials and Methods: Patients with class III malocclusion undergoing Lefort I advancement with and without impaction and bilateral sagittal split osteotomy with the standard technique were included in this study. Patients were divided into two groups: maxillary Lefort I advancement alone (group 1) and combined with impaction (group 2). Facial soft tissue landmarks of the nose including nasal height (NH), nasal length (NL), nasal tip projection (NTP), alar width (AW), alar base width (ABW), subalar width (Sbal), nasolabial angle (NLA), nasofrontal angle (NFA), and columella inclination (CI) before and at least 4 months after surgery were obtained by a 3D scanner., Results: Twenty-one patients were included in this study (Group 1: 11 and Group 2: 10). NH, NTP, and NL decreased significantly in both groups following surgery. In addition, Sbal decreased only in group 2. On the other hand, NLA and CI increased significantly in group 2. The inter-group comparison revealed a statistically significant difference in the alterations in NH, NL, and CI between the two groups., Conclusion: Changes in the nose soft tissue occurred after both surgeries, but their type and extent were different. Actions taken to reduce unwanted changes need to be further investigated. To evaluate the changes, 3D photogrammetry scan is a feasible imaging technique that can be used, providing numerous benefits., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Context: Segment and osteosynthesis malposition resulting in patients' complaints (mainly about asymmetries) are encountered in orthofacial/orthognathic surgery., Objective, Design, and Setting: We planned to investigate the usefulness of intraoperative three-dimensional (3D) imaging concerning positioning and fixation of bone segments and osteosynthesis in orthognathic/orthofacial surgery. We performed a prospective study of non-consecutive cases. All patients receiving a bimaxillary osteotomy, genioplasty, and their combinations were included in the study from May 2016 to May 2020. Unilateral and bilateral sagittal split osteotomies were excluded. There were no gender and age limitations. All were intraoperatively examined using the BV Pulsera 3D-RX System (Philips Medical, Eindhoven, The Netherlands). The outcome variables were the percentage of revisions of segment positioning and osteosynthesis. Predictor variables were age, gender, type of surgery, timing (pre- and post-imaging), and surgeon experience (senior vs assistant)., Results: Forty female and twenty-two male patients were included (mean age 25.25 years ± 7.52 and 29.1 years ± 12.6 respectively). We evaluated 27 genioplasties and 34 Le Fort "type-I" osteotomies. Indications for segment repositioning and redo-osteosynthesis increased after intraoperative imaging as compared to operator's clinical judgment before intraoperative imaging (95% confidence interval; p < .001 and p = .002 respectively)., Conclusion: Suboptimal positioning and fixation of bone segments or osteosynthesis were more apparent with 3D imaging. In addition, some satisfactory cases were also revised for an optimal outcome. As a result, surgeons were prompted to more revisions than judged necessary without intraoperative imaging., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery., Methods: The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery., Results: This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted., Conclusion: Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence., Competing Interests: Declaration of Competing Interest There are no conflict of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Customization in orthognathic surgery allows better precision and a reduced surgical time. In Le Fort I osteotomy surgery, the maxillary segmentation is considered one of the most unstable procedures due to transverse instability. Various different types of palatal device have been proposed to address this instability. This note describes a customized bone-borne palatal guide and splint that may help surgeons shorten the surgical time and achieve better three-dimensional repositioning, with more postoperative comfort for the patient and occlusal control for the surgeon., Competing Interests: Competing Interests Nothing to declare., (Copyright © 2023 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to evaluate the sensory function of the infraorbital nerve after orthognathic surgery (OS)., Materials and Methods: Patients who underwent Le Fort I osteotomy with or without BSSO for dentofacial deformity treatment were studied. Two groups were created according to whether BSSO was performed. Class A tests were performed to determine the degree of peripheral nerve damage. The Class B test was performed if decreased sensation was detected in at least one of these tests. A Class C test was performed if abnormal sensation was detected., Results: Twenty-eight patients (n=56) who underwent OS were included in this prospective study. Of the patients, 57.1% were female, 42.9% were male, and the mean age was 24.6 (±3.8). Seven patients were in group 1 (n=14), and 21 patients were in group 2 (n=42). In both groups, there were statistically significant differences between T1 and T2 (p<0.001), and the mean NSD score at T2 was higher than that at T1. The mean NSD score in the single jaw group was higher than that in the double jaw group at all time points., Conclusions: Bimaxillary surgeries had a negative effect on the somatosensory changes that developed in the early period. The upper lip's somatosensorial recovery was faster than IOR and single jaw recovery was faster than double jaw., Clinical Relevance: Maxillofacial surgeons performing orthognathic surgery should be aware that in double jaw operations, changes in the somatosensory function of the ION are more severe., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: After maxillary osteotomy in orthognathic surgery, patients report nasal breathing discomfort in early postoperative period. Topical hyaluronic acid (HA) has been proven to have beneficial effects on the upper airway tract mucosa. This prospective randomized controlled study was designed to analyze the effect on nasal obstruction of nebulized HA during the recovery process after maxillary osteotomy., Methods: Patients were randomized to control and treatment groups. The postoperative treatment differed only for additional nebulized HA provided to the treatment group. The level of nasal obstruction, and its impact on quality of life, was assessed every 3 days for the first 15 days postoperatively using a questionnaire. Demographic and other variables (maxillary osteotomy type and surgical movements) were analyzed. Differences in quantitative data were tested using Student's t-test, the Mann-Whitney U test, and mixed repeated measures ANOVA., Results: Twenty-four subjects were included in each group; differences in age, sex, type of maxillary osteotomy, and movements were non-statistically significative. At the beginning of treatment (T0), the two groups had comparable questionnaire scores regarding nasal breathing discomfort (p >0.05), whereas statistically significant differences were found at days 3, 6, 9, and 12 (p <0.05). A significant decrease in nasal breathing discomfort over time was observed in both groups, with trends that differed between the two, indicating faster improvement in the treatment group., Conclusion: Nebulized HA can be a useful additional treatment in early postoperative period after orthognathic surgery. Patients reported more rapid improvement of nasal respiratory symptoms, indicating a potential role for HA in reducing recovery time and patient discomfort after maxillary surgery., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)