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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
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Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians.

Chenzhi Lai1, Guodong Song1, Xianlei Zong1

  • 1Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Road, Shijingshan District, Beijing, People's Republic of China.

Aesthetic Plastic Surgery
|February 22, 2021
PubMed
Summary

Surgery-first sagittal split ramus osteotomies (SF-SSRO) can leave facial contour disharmony. A two-stage approach combining orthognathic surgery with facial bone contouring significantly improves patient aesthetics and satisfaction.

Keywords:
Computer-assisted designMandibular plastyOrthognathic surgerySagittal split ramus osteotomiesSurgery-first

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic Surgery
  • Aesthetic Surgery

Background:

  • Surgery-first sagittal split ramus osteotomies (SF-SSRO) effectively treat dental malocclusion.
  • However, residual facial contour deficiencies can cause disharmony and patient dissatisfaction after initial orthognathic surgery.
  • Mandibular prognathism often presents with underlying facial deficiencies not fully corrected by standard orthognathic procedures.

Purpose of the Study:

  • To evaluate the efficacy of a two-stage surgical approach for correcting residual facial deformities after SF-SSRO.
  • To improve facial contour harmony and patient satisfaction in cases of persistent disharmony post-orthognathic surgery.

Main Methods:

  • Twenty-five unsatisfied patients underwent preoperative CT scans to assess facial deformities.
  • Treatment involved mandible long-curve osteotomy, U-shaped osteotomy, genioplasty, or autologous fat grafting, guided by CAD, to refine facial contours.
  • Surgical techniques were selected based on individual patient contour deformities.

Main Results:

  • Following SF-SSRO, the gonial angle improved, and mandibular width decreased after mandibular outer plate grinding.
  • Subsequent facial refinement surgery significantly increased the gonial angle (p < 0.05) and further reduced mandibular width (p < 0.05).
  • No early complications like infection or osteonecrosis were observed, and patients reported high satisfaction with aesthetic outcomes.

Conclusions:

  • A two-stage orthognathic and facial bone contouring surgery is clinically feasible for treating dentofacial deformities.
  • This staged approach offers enhanced aesthetic improvements through more accurate facial contour refinement.
  • The combined strategy addresses residual deformities, leading to greater patient satisfaction.