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Surgery-first segmental orthognathic surgery for treatment of hemimandibular elongation: a novel modified modality
Jiawen Si1, Yilang Du1, Jingyang Huang1
1Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
Background:
The application of a surgery-first approach in patients with hemimandibular elongation (HE) remains poorly defined. In this pilot study, we introduce a modified surgery-first segmental orthognathic surgery (OGS) technique that integrates novel osteotomy design and structural precision to address HE.
Methods:
Nine patients with HE underwent segmental Le Fort I osteotomy, bilateral sagittal split ramus osteotomy (BSSRO), and unilateral mandibular body osteotomy, using both virtual surgical planning (VSP) and individualized cutting guides. Surgical accuracy was evaluated by comparing three-dimensional (3D) models obtained at 1 week postoperatively (T1) with VSP. Mid-term skeletal stability was assessed by comparing 3D models at T1 with those at 6-12 months postoperatively (T2). Symmetry-related parameters (chin deviation, chin rotation, bilateral mandibular body length discrepancy, and asymmetry index) were measured and compared.
Results:
All patients healed uneventfully without major complications. Surgical accuracy analysis showed a mean 3D deviation of 1.58 ± 0.39 mm between VSP and T1. Significant improvements were observed in all symmetry parameters at T1 (p < 0.05). At mid-term follow-up (mean 8.2 months, range 6-12 months), chin deviation, chin rotation, bilateral mandibular body length discrepancy, and asymmetry index showed no significant changes from T1 to T2.
Conclusions:
This pilot study demonstrates that the modified surgery-first segmental OGS technique achieves good surgical accuracy, immediate improvement in facial symmetry, and acceptable mid-term skeletal stability. This approach, integrating a unique osteotomy design, VSP, and 3D-printed cutting guides, offers a promising preliminary solution for complex facial asymmetry.
