Our Summary

This research paper discusses how advancements in technology are impacting orthognathic surgery - a procedure that corrects conditions related to the structure of the jaw and face. One of these advancements is Virtual Surgical Planning (VSP), which allows surgeons to create custom plates for use in surgery. The study looks at the experiences of one surgeon who has been using VSP for over a decade and started using custom plates in 2019.

The study analyzed patient data from 2016 to 2021. All patients underwent VSP and a process to create a model of their jaw (stereolithographic splint formation). After this, they either had traditional surgery where plates were bent to fit their face during the operation, or they had surgery with custom plates that were made and bent to fit their face beforehand.

Out of 43 patients, 25 had traditional surgery and 18 had surgery with custom plates. The technique for using custom plates evolved over time, and the most recent method involves using a mix of custom and traditional plates. The study found that surgeries with custom plates were quicker (233 minutes compared to 283 minutes) and there was no significant difference in the rate of complications.

In conclusion, using custom plates and specific cutting guides can make orthognathic surgery more efficient and precise. However, there are challenges to overcome when adopting this new technology. The research paper shares insights and technical modifications based on the surgeon’s experience to help others who may want to utilize this new method.

FAQs

  1. What is the difference between traditional and custom-plate fixation in orthognathic surgery?
  2. Has the adoption of custom plates in orthognathic surgery resulted in any changes to the surgical process or outcomes?
  3. How does the use of virtual surgical planning and custom plates impact the operative time in orthognathic surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about orthognathic surgery is to follow all pre-operative instructions carefully, including any dietary restrictions and medication guidelines. It is important to have a clear understanding of the surgical plan and post-operative care to ensure a successful recovery. Additionally, maintaining good oral hygiene before and after surgery can help prevent infection and promote healing.

Suitable For

Patients who are typically recommended for orthognathic surgery include those with:

  1. Severe malocclusion: Patients with severe misalignment of the jaws, causing functional issues such as difficulty chewing, speaking, or breathing.

  2. Skeletal discrepancies: Patients with significant skeletal discrepancies between the upper and lower jaws, leading to an uneven facial appearance or difficulty with bite alignment.

  3. Facial asymmetry: Patients with facial asymmetry due to skeletal abnormalities, such as a protruding or retrusive jaw.

  4. Obstructive sleep apnea: Patients with obstructive sleep apnea caused by a narrow airway due to jaw misalignment.

  5. Temporomandibular joint (TMJ) disorders: Patients with TMJ disorders that are related to jaw misalignment and cannot be managed conservatively.

  6. Esthetic concerns: Patients who have esthetic concerns related to the appearance of their facial profile due to jaw misalignment.

Overall, orthognathic surgery is recommended for patients who have significant functional or esthetic issues related to jaw misalignment that cannot be corrected with orthodontic treatment alone.

Timeline

Before orthognathic surgery:

  1. Consultation: The patient meets with an oral and maxillofacial surgeon to discuss their concerns and potential treatment options.
  2. Preoperative planning: The surgeon uses virtual surgical planning (VSP) to create a detailed treatment plan for the patient’s surgery.
  3. Orthodontic treatment: The patient may undergo orthodontic treatment to align their teeth before surgery.
  4. Pre-surgical evaluations: The patient undergoes various evaluations such as dental x-rays, CT scans, and blood tests to ensure they are healthy for surgery.

After orthognathic surgery:

  1. Hospital stay: The patient may stay in the hospital for a few days following surgery to monitor for any complications.
  2. Pain management: The patient will be prescribed pain medications to manage any discomfort post-surgery.
  3. Follow-up appointments: The patient will have regular follow-up appointments with the surgeon to monitor healing and adjust any orthodontic treatment.
  4. Orthodontic treatment: The patient continues with orthodontic treatment to fine-tune their bite and align their teeth.
  5. Long-term follow-up: The patient will continue to have periodic follow-up appointments with the surgeon to monitor long-term outcomes and address any issues that may arise.

What to Ask Your Doctor

  1. What are the potential benefits of using custom plates in orthognathic surgery compared to traditional fixation hardware?
  2. What is the process for creating custom plates and how does it differ from traditional fixation methods?
  3. Are there any potential risks or complications associated with using custom plates in orthognathic surgery?
  4. How does the use of custom plates impact the overall surgical experience and recovery for the patient?
  5. What specific modifications or advancements have been made in the surgical technique with the use of custom plates?
  6. How does the cost of using custom plates compare to traditional fixation hardware in orthognathic surgery?
  7. What level of experience and expertise does the surgical team need to successfully utilize custom plates in orthognathic surgery?
  8. Are there any specific factors that would make a patient a better candidate for custom plate fixation in orthognathic surgery?
  9. What follow-up care or monitoring is needed for patients who undergo orthognathic surgery with custom plates?
  10. Are there any ongoing research or advancements in the field of orthognathic surgery that may further improve the use of custom plates in the future?

Reference

Authors: Fleury CM, Sayyed AA, Baker SB. Journal: J Craniofac Surg. 2022 Oct 1;33(7):1976-1981. doi: 10.1097/SCS.0000000000008574. Epub 2022 Feb 18. PMID: 35184108