The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis

  • Yoon-Ji Kim (Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon-Young Kim (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Nayansi Jha (Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min-Ho Jung (Department of Orthodontics, Dental Research Institute and School of Dentistry, Seoul National University) ;
  • Yong-Dae Kwon (Department of Oral and Maxillofacial Surgery, College of Dentistry, Kyung Hee University) ;
  • Ho Gyun Shin (Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Min Jung Ko (Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Sang Ho Jun (Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital)
  • Received : 2023.09.27
  • Accepted : 2024.01.18
  • Published : 2024.03.25
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Abstract

Objective: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

Keywords

Acknowledgement

This research was supported by the grants from the National Evidence-based Healthcare Collaborating Agency (NECA, No. NA-21-010, NA22-007) and the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C2009296).

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