Three-dimensional soft tissue simulation has become a popular tool in the process of virtual orthognathic surgery planning and patient–surgeon communication. To apply 3D soft tissue simulation software in routine clinical practice, both qualitative and quantitative validation of its accuracy are required. The objective of this study was to systematically review the literature on the accuracy of 3D soft tissue simulation in orthognathic surgery. The Web of Science, PubMed, Cochrane, and Embase databases were consulted for the literature search. The systematic review (SR) was conducted according to the PRISMA statement, and 40 articles fulfilled the inclusion and exclusion criteria. The Quadas-2 tool was used for the risk of bias assessment for selected studies. A mean error varying from 0.27 mm to 2.9 mm for 3D soft tissue simulations for the whole face was reported. In the studies evaluating 3D soft tissue simulation accuracy after a Le Fort I osteotomy only, the upper lip and paranasal regions were reported to have the largest error, while after an isolated bilateral sagittal split osteotomy, the largest error was reported for the lower lip and chin regions. In the studies evaluating simulation after bimaxillary osteotomy with or without genioplasty, the highest inaccuracy was reported at the level of the lips, predominantly the lower lip, chin, and, sometimes, the paranasal regions. Due to the variability in the study designs and analysis methods, a direct comparison was not possible. Therefore, based on the results of this SR, guidelines to systematize the workflow for evaluating the accuracy of 3D soft tissue simulations in orthognathic surgery in future studies are proposed.

Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.

The analysis aims at assessing the current trends in orthognathic surgery. The retrospective study covered a group of 124 patients with skeletal malocclusion treated by one team of maxillofacial surgeons at the University Hospital in Zielona Góra, Poland. Various variables were analysed, including demographic characteristics of the group, type of deformity, type of osteotomy used, order in which osteotomy was performed and duration of types of surgery. The mean age of the patients was 28 (ranging from 17 to 48, SD = 7). The group included a slightly bigger number of females (59.7%), with the dominant skeletal Class III (64.5%), and asymmetries were found in 21.8% of cases. Types of osteotomy performed during surgeries were divided as follows: LeFort I, segmental LeFort I, BSSO, BSSO with genioplasty, LeFort I with BSSO, LeFort I with BSSO and genioplasty, segmental LeFort I with BSSO, isolated genioplasty. Bimaxillary surgeries with and without genioplasty constituted the largest group of orthognathic surgeries (49.1%), and a slightly smaller percentage were one jaw surgeries (46.7%). A statistically significant correlation was found between the type of surgery and the skeletal class. In patients with skeletal Class III, bimaxillary surgeries were performed significantly more often than in patients with skeletal Class II (57.5% vs. 20.0%; p = 0.0002). The most common type of osteotomy in all surgeries was bilateral osteotomy of the mandible modo Obwegeser–Epker in combination with Le Fort I maxillary osteotomy (42.7%). The order of osteotomies in bimaxillary surgeries was mandible first in 61.3% of cases. The longest surgery was bimaxillary osteotomy with genioplasty (mean = 265 min), and the shortest surgery was isolated genioplasty (mean = 96 min). The results of the analysis show a significant differentiation between the needs of orthognathic surgery and the types of corrective osteotomy applied to the facial skeleton.

Background and Objectives: Despite the well-established position of orthognathic surgery as a field of surgical treatment of deformities within the facial skeleton, it has not been possible to develop unanimous recommendations on how to approach fixation hardware after the healing period. In the absence of clear guidelines from opinion leaders and scientific societies on how to approach osteosynthesis after surgery, the decision to leave or remove fixation hardware is made individually by treatment centers, mostly based on their own experience. It is also important whether or not surgical procedures are financed by public funds. This issue extends beyond orthognathic surgery, affecting all facial skeleton procedures involving osteosynthesis materials. The aim of this study is to analyze the frequency and reasons for fixation hardware removal after orthognathic surgery in patients treated in one center. Materials and Methods: This retrospective study examined the medical records from 2015 to 2020 of patients treated surgically for skeletal deformities at the Department and Clinic of Otolaryngology and Maxillofacial Surgery of Collegium Medicum (formerly the Otolaryngology Department of the Provincial Hospital in Zielona Góra). This study analyzed the age and sex of patients, the type of orthognathic procedure, and the type of skeletal deformity, as well as the reasons for fixation hardware removal in the groups of patients. Results: During this period, 124 orthognathic procedures were performed, including 56 one-jaw operations (BSSO or Le Fort I maxillary osteotomy), 2 one-jaw operations with genioplasty, 55 bimaxillary operations (BSSO + Le Fort I maxillary osteotomy), 6 bimaxillary surgery with genioplasty and 5 isolated genioplasty procedures. Fixation hardware was removed in 77 cases (62.10% of procedures), comprising 57 women and 20 men. Reasons for osteosynthesis removal were divided into three groups: complications such as the occurrence of inflammatory reaction/infection (n = 17), subjective discomfort (n = 23), and patient requests (n = 37). Conclusions: The findings underscore the need for scientific societies to establish unified guidelines on managing post-surgical fixation hardware to standardize care and enhance patient outcomes.

Background/Objectives: This single-patient retrospective study evaluated the technical feasibility of serial infrared thermography (IRT) for intraoperative and postoperative surface-temperature documentation of free-flap skin islands and its descriptive concordance with clinical and vascular assessments. Methods: A 9-year-old boy with Nager syndrome undergoing bilateral temporomandibular joint reconstruction and soft-tissue reconstruction with an anterolateral thigh free flap divided into two skin islands was monitored intraoperatively and postoperatively. Thermograms were acquired using a FLIR T1020 camera (emissivity 0.98) under documented environmental conditions. Intraoperative and postoperative observations were interpreted separately, without normalisation between settings. Mean temperatures within manually delineated regions of interest and inter-island differences were analysed retrospectively and compared descriptively with documented clinical assessment, Doppler ultrasonography, and computed tomography angiography (CTA) findings. Results: Pallor prompted Doppler ultrasonography, followed by CTA; these showed absent right-perforator flow and non-visualisation of that perforator, respectively. The skin did not bleed after puncture. Thermography was performed after these tests and was not taken into account when making the decision about reoperation. IRT demonstrated temperature changes in both skin islands. At 49 h after the initial flap measurement, the mean surface temperature was 26.6 °C in the right skin island and 32.7 °C in the left (absolute difference, 6.1 °C). A focal area of relatively increased surface temperature “hot spot” was identified retrospectively within the viable left skin island; this qualitative observation was exploratory and was not based on a prespecified thermal threshold. Conclusions: Serial IRT was feasible and provided contactless thermal information retrospectively concordant with multimodal perfusion assessment. These findings are hypothesis-generating and do not establish earlier detection, diagnostic accuracy, or a universal thermal threshold; larger prospective studies are required.