Follow-up Following the Surgery-First Approach

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© Springer Nature Singapore Pte Ltd. 2021

J.-W. Choi, J. Y. LeeThe Surgery-First Orthognathic Approachdoi.org/10.1007/978-981-15-7541-9_14

14. Long-term Follow-up Following the Surgery-First Approach

Jong-Woo Choi1   and Jang Yeol Lee2  
(1)

Department of Plastic Surgery, Asan Medical Center, Seoul, Korea (Republic of)
(2)

SmileAgain Orthodontic Center, Seoul, Korea (Republic of)
 
 
Jong-Woo Choi (Corresponding author)
 
Jang Yeol Lee
Keywords

Long-term follow upStabilitySkeletal stability Orthognathic surgery

Many surgeons and orthodontists are very curious about the long-term outcomes, including stability, following the surgery-first approach (SFA). I explained and described SFA-related stability issues in the previous chapter; this chapter focuses on long-term surgical outcomes, including facial aesthetics and occlusion, in clinical cases. Many surgeons suggested the method how the relapse is minimized and the skeletal stability is maintained [1, 2, 57].

The surgery-first orthognathic concept was introduced in our practice to address the above-mentioned issues. Since its initial 2001 presentation, titled “functional orthognathic surgery,” we have actively applied SFA. We understand that there are numerous concerns regarding this approach; however, many surgeons have recently published outcomes on this topic. Nonetheless, different authors have widely varying philosophies and methodologies.

Our application of SFA does not simply omit presurgical orthodontic treatment. Rather, it begins with a functional concept that is based on presurgical orthodontic treatment simulated on a dental model (Fig. 14.1). Based on the results of these analyses, we determine whether SFA should be performed. Among recently published articles, there are very few reports of large-scale, long-term stability outcomes. We analyzed our SFA data, based on cephalometric analyses, and compared the traditional and surgery-first approaches (Figs. 14.2, 14.3).

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Fig. 14.1

(a) Standard model mounting process. (b) Before this procedure, teeth that were already adapted to the skeletal discrepancy were simulated and reorganized into their predicted locations based on the presurgical orthodontic treatment. This process is done by separating each tooth from the model, and simulation and reorganization are accomplished during the real presurgical orthodontic treatment. (c) Thereafter, simulation of the actual orthognathic surgery, similar to that of the standard approach, was performed. (d) At this point, if we substitute the new dental model for the original before the presurgical orthodontic treatment, we acquire the model after the orthognathic surgery without presurgical orthodontics. According to this surgical model, we can make the intermediate and final wafers for the surgery-first approach

../images/482096_1_En_14_Chapter/482096_1_En_14_Fig2a_HTML.png../images/482096_1_En_14_Chapter/482096_1_En_14_Fig2b_HTML.png../images/482096_1_En_14_Chapter/482096_1_En_14_Fig2c_HTML.png
Fig. 14.2

A 25-year-old male patient with skeletal Class III dentofacial deformity. The surgery-first approach was performed. (a, b) Preoperative frontal and oblique views. (c, d) Postoperative frontal and oblique views after 4 years. (e) Preoperative view and (g) postoperative occlusal view after 4 years. (j) Postoperative lateral cephalogram after 7 years

../images/482096_1_En_14_Chapter/482096_1_En_14_Fig3a_HTML.png../images/482096_1_En_14_Chapter/482096_1_En_14_Fig3b_HTML.png../images/482096_1_En_14_Chapter/482096_1_En_14_Fig3c_HTML.png
Fig. 14.3

Long-term follow-up results following the traditional orthognathic approach for a patient with a Class III dentofacial deformity

14.1 Results

In total, 104 patients (66 females) with Class III deformities were enrolled in the SFA group and 51 similar patients (35 females) were enrolled in the traditional approach group. The patients in both groups were ethnic Asians and had average ages of 23.3 years (SFA group) and 23.1 years (traditional group). The follow-up period ranged from 17.3 to 121.2 months (average, 74.0 months). Satisfactory results were achieved in all 155 patients with dentofacial deformities, in this study and none required additional surgeries to resolve occlusal instability. There were no major complications, such as serious infections, malocclusions, or fixation failures; two patients experienced mild wound infections, which resolved after 10 days of antibiotic treatment. The baseline cephalometric landmarks are shown (Table 14.1). Overall, the analyses revealed that anteroposterior skeletal stability in the SFA group was statistically similar to that in the traditional group. Initially, we investigated whether the two groups had preoperative differences in their cephalometric landmarks. The presurgical cephalometric analysis failed to reveal any significant differences in preoperative horizontal skeletal landmarks, except for the angle of lines connecting the sella, nasion, and point B (SNB), vertical reference plane (VRP) to point B, and VRP to the anterior nasal spine (ANS) and point A. The differences meant that more severe Class III dentofacial deformities were present in the SFA group than in the traditional group [14].

Table 14.1

 Preoperative comparison between the orthodontic- and surgery-first groups at T0 for initial evaluation of cephalometric differences

 

Orthodontics-first (n = 51)

Surgery-first (n = 104)

P

Mean

SD

Mean

SD

Horizontal skeletal pattern

A to N perp

−2.46

5.79

−0.9

4.53

0.0989

Pog to N perp

−3.72

10.13

1.28

9.2

0.0026*

SNA

77.98

5.57

79.52

4.43

0.0656

SNB

77.79

5.45

80.17

4.85

0.0069*

ANB difference

0.2

4.45

−0.64

3.79

0.2252

APDI

90.24

9.97

90.86

7.76

0.7006

Combination factor

154.86

9.86

152.27

9.16

0.112

Wits

−5.45

4.74

−6.6

4.6

0.1525

Facial convexity

−0.98

10.35

−2.73

8.45

0.2658

Ramus height

52.51

7.12

52.72

6.22

0.8527

Body length

76.26

6.26

79.74

7.53

0.0052*

Body to ant cranial base ratio

1.15

0.09

1.17

0.1

0.191

FABA

87.68

9.7

90.67

8.09

0.0458*

FH to OP

10.71

6.15

9.13

4.9

0.0864

VRP to ANS

65.45

7.7

68.84

7.42

0.0098*

VRP to PNS

17.09

4.78

18.5

4.15

0.0617

VRP to A

60.37

8.12

63.89

7.38

0.008*

VRP to B

56.03

11.79

62.29

10.67

0.0012*

A point A, ANB angle of lines connecting point A, the nasion, and point B, ANS anterior nasal spine, APDI anteroposterior dysplasia indicator, FABA Frankfort horizontal line to AB plane angle, FH Frankfort horizontal line, N nasion, per perpendicular, PNS posterior nasal spine, Pog pogonion, SNA angle of lines connecting the sella, nasion, and point A, SNB angle of lines connecting the sella, nasion, and point B, VRP vertical reference plane

*P < 0.05

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Mar 5, 2021 | Posted by in Orthodontics | Comments Off on Follow-up Following the Surgery-First Approach
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