• Archives of Plastic Surgery
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• 제48권2호
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• pp.199-207
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• 2021

Traditional orthognathic surgery has long been performed after presurgical orthodontic treatment. Despite some concerns, the surgery-first orthognathic approach (SFOA) or surgery-first approach (SFA) without presurgical orthodontic treatment has gradually gained popularity. In recent years, several articles dealing with the concepts of the SFA have been published worldwide. However, the SFA has not yet been standardized, and many surgeons use slightly different protocols and concepts. This review article discusses the beginning and evolution of the SFA and its current concepts, including some opinions based on the authors' clinical experiences over the last 15 years. According to recent investigations, the SFA could be applied effectively in several situations including class III malocclusion, class II malocclusion, and facial asymmetry. However, debate on the SFA continues and many issues remain to be resolved. This review article addresses the current issues regarding the SFOA, including its advantages and disadvantages, as well as its indications and contraindications. The authors summarize various aspects of the SFA and expect that this review article will help surgeons and orthodontists better understand the current status of the SFA.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권1호
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• pp.23-28
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• 2017

Objectives: The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). Materials and Methods: The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). Results: The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was $2.23{\pm}0.92mm$ (P<0.01) forward movement and $-0.87{\pm}0.57mm$ (non-significant, NS) upward movement on the basis of point B and $2.54{\pm}1.37mm$ (P<0.01) forward movement and $-1.18{\pm}0.79mm$ (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was $3.49{\pm}1.71mm$ (P<0.01) forward movement and $-1.78{\pm}0.81mm$ (P<0.01) upward movement on the basis of the point B and $4.11{\pm}1.93mm$ (P<0.01) forward movement and $-2.40{\pm}0.98mm$ (P<0.01) upward movement on the basis of the Pog. Conclusion: The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

• Journal of Korean Dental Science
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• 제10권1호
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• pp.35-44
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• 2017

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.23.1-23.10
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• 2019

The choice of surgical technique in orthognathic surgery is based primarily on the surgical treatment objectives (STO), which is a fundamental component of the orthognathic treatment process. In the conventional orthodontics-first approach, presurgical planning can be performed twice, during the preorthodontic (initial STO) and presurgical phases (final STO). Recently, a surgery-first orthognathic approach (SFA) without presurgical orthodontic treatment has been introduced and combined initial and final STO at the same time. In contrast to the conventional surgical-orthodontic treatment protocol that includes preoperative orthodontics for dental decompensations to maximize stable postoperative occlusion, the SFA potentially shortens the treatment period and minimizes esthetic concerns during the decompensation period because skeletal problems are corrected from the beginning. The indications for the SFA have been proposed in the literature, but no consensus exists. Moreover, because dental occlusion of the pre-orthodontic arches cannot be used as a guide for establishing the surgical treatment plan, there are fundamental limitations in accurate prediction of postsurgical results in the SFA. Recently, the concepts of postsurgical orthodontic treatment are continuously changing and evolving to overcome this inherent limitation of the SFA. The elimination of presurgical orthodontics can change the paradigm of orthognathic surgery but still requires cautious case selection and thorough discussion and collaboration between orthodontists and surgeons regarding the goals and postoperative management of the orthognathic procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권2호
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• pp.96-100
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• 2012

Objectives: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. Materials and Methods: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and $40{\times}40$ pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. Results: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. Conclusion: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.

• 대한치과의사협회지
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• 제50권11호
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• pp.670-676
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• 2012

Distraction osteogenesis and orthognathic surgery are the widely used surgical methods for treating hemifacial microsomia and cleft lip and palate, the representative forms of congenital deformity. Distraction osteogenesis is an outstanding treatment of choice when more traction is needed than what can be achieved by general orthognathic surgery. However, the stability of distraction osteogenesis has not yet been established, and in most of the cases, additional orthognathic surgery is mandatory. Moreover, the difficulty in precise control of the traction directions is another disadvantage of distraction osteogenesis. Therefore, it would be desirable not to conduct distraction osteogenesis when the patient is suitable for an orthognathic surgery. Also, distraction osteogenesis should be recognized as an accessorial method of treatment, and be used restrictively.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.6.1-6.9
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• 2015

Orthognathic surgery requires stable fixation for uneventful healing of osteotomized bony segments and optimal remodeling. Titanium plates and screws have been accepted as the gold standard for rigid fixation in orthognathic surgery. Although titanium osteofixation is the most widely used approach, the use of bioabsorbable devices has been increasing recently. Biodegradation of bioabsorbable devices eliminates the need for a second operation to remove metal plates and screws. However, long-term stability and relapse frequency in bioabsorbable osteofixation are still insufficiently studied, especially in cases of segmental movements of great magnitude or segmental movements to a position where bony resistance exists. This paper reviews the background, techniques, and complications of bioabsorbable osteofixation and compares bioabsorbable and titanium osteofixation in orthognathic surgery in terms of skeletal stability.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권1호
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• pp.3-15
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• 2017

While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic surgery lies on the aesthetic side or the functional side. There is a wide variety of complications associated with orthognathic surgery. There should be a clear distinction between malpractice and complications. Complications can be resolved without any serious problems if the cause is detected early and adequate treatment provided. Oral and maxillofacial surgeons must have a full understanding of the types, causes, and treatment of complications, and should deliver this information to patients who develop these complications.

• Imaging Science in Dentistry
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• 제52권4호
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• pp.409-413
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• 2022

This report presents a rare case where a displaced temporomandibular joint (TMJ) disc was reduced to its normal position after orthognathic surgery, and long-term magnetic resonance imaging (MRI) follow-up visualized these postoperative changes. A 22-year-old male patient presented for facial asymmetry. He also complained of pain in the right TMJ area, and MRI showed disc displacements in both TMJs. After orthognathic surgery for facial asymmetry correction, the TMJ was re-evaluated. The symptom had resolved and the disc was positioned within the normal range during mouth opening. However, 6 and a half years after surgery, he complained of recurrent pain in the right joint, and MRI revealed medial disc displacement in the right TMJ. In conclusion, the influence of orthognathic surgery on the disc position might continue for a long time until the TMJ adapts to the new position. Careful and long-term follow-up is suggested to assess the TMJ complex.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권2호
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• pp.86-93
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• 2024

Objectives: Orthognathic surgery is a surgical procedure performed by intraoral approach with established and safe techniques; however, excessive blood loss has been reported in rare cases. In response, investigative efforts to identify methods to reduce the amount of blood loss have been made. Among such methods, the administration of tranexamic acid was reported to reduce the amount of intraoperative blood loss. However, few studies to date have reported the effect of tranexamic acid in orthognathic surgery under hypotensive anesthesia. The present study aimed to investigate the effect of the administration of tranexamic acid on intraoperative blood loss in patients undergoing bimaxillary (maxillary and mandibular) orthognathic surgery under hypotensive anesthesia. Patients and Methods: A total of 156 patients (mean age, 27.0±10.8 years) who underwent bimaxillary orthognathic surgery under hypotensive anesthesia performed by the same surgeon between June 2013 and February 2022 were included in this study. The following data were collected from the medical records of each patient: background factors (age, sex, and body mass index), use of tranexamic acid, surgical procedures, previous medical history, duration of surgery, American Society of Anesthesiology physical status findings before surgery, intraoperative blood loss as a primary outcome, in-out balance, and blood test results. Descriptive statistics were calculated for statistical analysis, and a t-test and the chi-squared test were used for between-group comparisons. Group comparisons were performed after 1:1 propensity score matching to adjust for confounding factors. Statistical significance was set at P<0.05. Results: Comparison between the groups based on the use of tranexamic acid revealed a significant difference in operation time. Propensity score matching analysis revealed that intraoperative blood loss was significantly lower in the tranexamic acid group. Conclusion: The administration of tranexamic acid was effective in reducing intraoperative blood loss in patients undergoing bimaxillary orthognathic surgery under hypotensive anesthesia.