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O.378 Long-term patient satisfaction after orthognatic surgery
Oral Presentations
Orthognathic surgery III
O.377 Le Fort I and paranasal aesthetics: an overview of the literature N. Loomans, C. De Clercq, P. Lamoral, F. Lippens, N. Neyt, G. Swennen, J. Abeloos. Department of Surgery, Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium Objectives: A review of the literature on nasolabial changes after Le Fort I osteotomy was performed. from 01/01/1976 until 31/03/2008. Methods and parameters of measurements were compared and evaluated for their validity. Introduction: The effects of nasal and labial changes after Le Fort I osteotomy, including widening of the alar base, upturning of the nasal tip and flattening of the upper lip, have been previously reported. To measure these changes profile cephalometric X-rays are used. The most common are the nasolabial angle, the nasal tip angle, the nasal tip protrusion and the interalar rim width. Methods and Materials: A review of the literature dealing with paranasal changes after Le Fort I osteotomy was conducted using the PubMed (US NLM-NIH) database from 01/01/1976 to 31/03/2008. Key words used in the search were: ‘paranasal aesthetics’; ‘Le Fort I osteotomy’; ‘nasal changes’; ‘nasolabial aesthetics’; ‘orthognatic surgery’; ‘soft tissue profile’. The search was limited to the English, French and German literature. Results: This search revealed 181 articles. Randomised clinical trials, prospective and retrospective trials describing measurements of nasolabial changes after Le Fort I osteotomy were included. The method and parameters of measurement were reviewed in detail. Conclusion: The results of this review showed that there are still no clear evidence-based data to compare and evaluate nasolabial changes after Le Fort I Osteotomy. Most of the studies don’t show numeric data and use different landmarks for their measurements. There is a clear need for a uniform measurement tool and a set of valid landmarks.
Tuesday, 9 September 2008, 14.00–16.00
Room 2
Orthognathic surgery III O.378 Long-term patient satisfaction after orthognatic surgery S. Fusetti, A. Marcocci, M. Ragazzo, G. Saia, G. Ferronato. University of Padova Medical School, Padova, Italy Objectives: In patients with dentofacial deformities, improvements in the occlusion, in the way of speaking, in the way of eating and in the face esthetics are primary motivations to surgery. This study evaluated patients outcome after combined orthodontic and orthognatic treatment. Methods: 23 patients (9 males and 13 females) who underwent combined orthodontic and orthognatic treatment between 2003 and 2007 answered a questionnaire about perceived satisfaction with the treatment. All data were analyzed using descriptive statistics and Chi square test. Photos taken during the treatment and x-rays-based cephalometric analyses were used to evaluate clinical outcome. The questionnaire investigated motivations that led the patient to surgery, complications of the interventions and perceived improvements after surgery. It also explored the amount of information received by the patient and its effectiveness. Results: Three motivations resulted to be the most important in the decision of having surgery were improvement of occlusion, of teeth alignment and of facial esthetic. Most perceived changes were in face appearance and was gender related. Females were more satisfied with the facial changes than man. Occlusion improvements were perceived more in younger patients. Among complications only swelling was more severe than expected. All patients received enough information about the treatment.
S95
Conclusions: The study suggest that patient satisfaction following joint orthodontic/orthognatic surgical treatment is high. Esthetic improvements seemed to be perceived more by females than males. Independently of the motivations and of the perceived improvements, all patients declared to be satisfied with the overall outcome. O.379 Malar augmentation in facial harmony A. Gritti, S. Banchini, L. Toma, M.L. Anghinoni, E. Sesenna. Azienda Ospedaliera Universitaria, U.O. Maxillo Facial Surgery, Parma, Italy Objectives: In maintaining facial harmony a key role is played by the relationships among the must important skeletal ridges (nose, zygomatic bones, dento-alveolar process, chin). The zygomatic profile is extremely important both in the conventional fontal and sagittal planes. The purpose of this study is to analyze the indications and the treatment outcome and long term stability in 80 patients with malar hypoplasia and treated with the malar augmentation associated with orthognatic surgery. Methods: In the Departiment of MaxilloFacial Surgery, University of Parma, from 1996 to 2007, 80 patients were treated with malar augmentation with orthognatic surgery (68 patients were a III skeleton class, and 12 patients were a II skeleton class). Our experience is based on the use of alloplastic implants. Results: The use of alloplastic matherials ensure more predictable results, and allows to restore the facial harmony, and ensure a pleasant esthetic effect. Conclusion: Esthetical problems related to malar hypoplasia are often neglected while evaluating patients effected by dentofacial deformities, although in many cases these bones are considerably hypoplastic. We analyse our personal experience in the correction of zygomatic hypoplasia associated with orthognatic surgery. O.380 Mandibular midline distraction using a tooth borne device R. Koehnke, O. Ploder, H. Winsauer. Dep. of Oral and Maxillofacial Surgery, Feldkirch, Austria Purpose: The aim of this study was to analyze the three dimensional movement of the mandible segments subsequent to distraction of the mandibular midline utilizing a bonded and bended tooth-borne appliance in a consecutive group of patients with transverse mandibular deficiency. Patients and Methods: Twenty patients with transverse deficiencies of the lower arch were included in this study. Prior to surgical intervention, a custom made appliance was cemented to the teeth and additionally fixed with two screws between the teeth on each side. The distraction appliance was activated after a five day latency period at a rate of 0.6 mm per day. After a consolidation period of six weeks, the appliance was removed and an orthodontic retainer was applied. Radiographs and cast models were taken pre- and postoperatively and direct linear measurements at the tooth and bone level were performed at the same intervals. Results: Mean expansion (±SD) of the osteotomy line measured on the radiographs for the superior, middle and inferior part of the mandible was 4.9±2.6, 5.6±3.1 and 5.4±3.1 mm, respectively. Overall expansion (±SD) was 5.6±2.6 mm. Width increase of the models between the canines, first and second premolars, first and second molars at the tooth level was 4.0±2.1, 5.1±2.3, 4.7±2.3, 4.2±1.7 and 3.6±2.1 mm, and 3.4±2.0, 3.8±1.8, 3.4±1.6, 3.2±1.6 and 2.2±1.8 mm at the bone level, respectively. Conclusions: Expansion of the osteotomy line in the vertical dimension showed a uniform pattern. Lateral movements of the mandibular segments decreased from the symphysis to the gonial angles. The positional changes of the teeth and the bone segments were proportional. Minimal dental movement was observed.
Orthognathic surgery III
O.377 Le Fort I and paranasal aesthetics: an overview of the literature N. Loomans, C. De Clercq, P. Lamoral, F. Lippens, N. Neyt, G. Swennen, J. Abeloos. Department of Surgery, Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium Objectives: A review of the literature on nasolabial changes after Le Fort I osteotomy was performed. from 01/01/1976 until 31/03/2008. Methods and parameters of measurements were compared and evaluated for their validity. Introduction: The effects of nasal and labial changes after Le Fort I osteotomy, including widening of the alar base, upturning of the nasal tip and flattening of the upper lip, have been previously reported. To measure these changes profile cephalometric X-rays are used. The most common are the nasolabial angle, the nasal tip angle, the nasal tip protrusion and the interalar rim width. Methods and Materials: A review of the literature dealing with paranasal changes after Le Fort I osteotomy was conducted using the PubMed (US NLM-NIH) database from 01/01/1976 to 31/03/2008. Key words used in the search were: ‘paranasal aesthetics’; ‘Le Fort I osteotomy’; ‘nasal changes’; ‘nasolabial aesthetics’; ‘orthognatic surgery’; ‘soft tissue profile’. The search was limited to the English, French and German literature. Results: This search revealed 181 articles. Randomised clinical trials, prospective and retrospective trials describing measurements of nasolabial changes after Le Fort I osteotomy were included. The method and parameters of measurement were reviewed in detail. Conclusion: The results of this review showed that there are still no clear evidence-based data to compare and evaluate nasolabial changes after Le Fort I Osteotomy. Most of the studies don’t show numeric data and use different landmarks for their measurements. There is a clear need for a uniform measurement tool and a set of valid landmarks.
Tuesday, 9 September 2008, 14.00–16.00
Room 2
Orthognathic surgery III O.378 Long-term patient satisfaction after orthognatic surgery S. Fusetti, A. Marcocci, M. Ragazzo, G. Saia, G. Ferronato. University of Padova Medical School, Padova, Italy Objectives: In patients with dentofacial deformities, improvements in the occlusion, in the way of speaking, in the way of eating and in the face esthetics are primary motivations to surgery. This study evaluated patients outcome after combined orthodontic and orthognatic treatment. Methods: 23 patients (9 males and 13 females) who underwent combined orthodontic and orthognatic treatment between 2003 and 2007 answered a questionnaire about perceived satisfaction with the treatment. All data were analyzed using descriptive statistics and Chi square test. Photos taken during the treatment and x-rays-based cephalometric analyses were used to evaluate clinical outcome. The questionnaire investigated motivations that led the patient to surgery, complications of the interventions and perceived improvements after surgery. It also explored the amount of information received by the patient and its effectiveness. Results: Three motivations resulted to be the most important in the decision of having surgery were improvement of occlusion, of teeth alignment and of facial esthetic. Most perceived changes were in face appearance and was gender related. Females were more satisfied with the facial changes than man. Occlusion improvements were perceived more in younger patients. Among complications only swelling was more severe than expected. All patients received enough information about the treatment.
S95
Conclusions: The study suggest that patient satisfaction following joint orthodontic/orthognatic surgical treatment is high. Esthetic improvements seemed to be perceived more by females than males. Independently of the motivations and of the perceived improvements, all patients declared to be satisfied with the overall outcome. O.379 Malar augmentation in facial harmony A. Gritti, S. Banchini, L. Toma, M.L. Anghinoni, E. Sesenna. Azienda Ospedaliera Universitaria, U.O. Maxillo Facial Surgery, Parma, Italy Objectives: In maintaining facial harmony a key role is played by the relationships among the must important skeletal ridges (nose, zygomatic bones, dento-alveolar process, chin). The zygomatic profile is extremely important both in the conventional fontal and sagittal planes. The purpose of this study is to analyze the indications and the treatment outcome and long term stability in 80 patients with malar hypoplasia and treated with the malar augmentation associated with orthognatic surgery. Methods: In the Departiment of MaxilloFacial Surgery, University of Parma, from 1996 to 2007, 80 patients were treated with malar augmentation with orthognatic surgery (68 patients were a III skeleton class, and 12 patients were a II skeleton class). Our experience is based on the use of alloplastic implants. Results: The use of alloplastic matherials ensure more predictable results, and allows to restore the facial harmony, and ensure a pleasant esthetic effect. Conclusion: Esthetical problems related to malar hypoplasia are often neglected while evaluating patients effected by dentofacial deformities, although in many cases these bones are considerably hypoplastic. We analyse our personal experience in the correction of zygomatic hypoplasia associated with orthognatic surgery. O.380 Mandibular midline distraction using a tooth borne device R. Koehnke, O. Ploder, H. Winsauer. Dep. of Oral and Maxillofacial Surgery, Feldkirch, Austria Purpose: The aim of this study was to analyze the three dimensional movement of the mandible segments subsequent to distraction of the mandibular midline utilizing a bonded and bended tooth-borne appliance in a consecutive group of patients with transverse mandibular deficiency. Patients and Methods: Twenty patients with transverse deficiencies of the lower arch were included in this study. Prior to surgical intervention, a custom made appliance was cemented to the teeth and additionally fixed with two screws between the teeth on each side. The distraction appliance was activated after a five day latency period at a rate of 0.6 mm per day. After a consolidation period of six weeks, the appliance was removed and an orthodontic retainer was applied. Radiographs and cast models were taken pre- and postoperatively and direct linear measurements at the tooth and bone level were performed at the same intervals. Results: Mean expansion (±SD) of the osteotomy line measured on the radiographs for the superior, middle and inferior part of the mandible was 4.9±2.6, 5.6±3.1 and 5.4±3.1 mm, respectively. Overall expansion (±SD) was 5.6±2.6 mm. Width increase of the models between the canines, first and second premolars, first and second molars at the tooth level was 4.0±2.1, 5.1±2.3, 4.7±2.3, 4.2±1.7 and 3.6±2.1 mm, and 3.4±2.0, 3.8±1.8, 3.4±1.6, 3.2±1.6 and 2.2±1.8 mm at the bone level, respectively. Conclusions: Expansion of the osteotomy line in the vertical dimension showed a uniform pattern. Lateral movements of the mandibular segments decreased from the symphysis to the gonial angles. The positional changes of the teeth and the bone segments were proportional. Minimal dental movement was observed.