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Approaching patients with panfacial fractures by using an anatomical reference: A novel concept and preliminary study

  • Author Footnotes
    # Te Ju Wu and Cheng Chun Wu contributed equally to this work.
    Te-Ju Wu
    Footnotes
    # Te Ju Wu and Cheng Chun Wu contributed equally to this work.
    Affiliations
    Department of Craniofacial Orthodontic, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Cheng Chun Wu
    Affiliations
    Department of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Department of Craniofacial Orthodontic, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Yuan Hao Yen
    Affiliations
    Department of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Yueh Ju Tsai
    Affiliations
    Department of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Po Lun Tsai
    Affiliations
    Department of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Yi Hao Lee
    Affiliations
    Department of Craniofacial Orthodontic, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chi Yu Tsai
    Affiliations
    Department of Craniofacial Orthodontic, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Jui Pin Lai
    Correspondence
    Corresponding author at: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, No.123, Dapi Road, Niaosong District, Kaohsiung City 833401, Taiwan.
    Affiliations
    Department of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Author Footnotes
    # Te Ju Wu and Cheng Chun Wu contributed equally to this work.

      Summary

      Panfacial fractures are challenging for craniofacial surgeons. Aside from involving multiple subunits, they also lack the reliability of a useful landmark of the facial skeleton. Properly, reducing and fixing palatal fracture to re-establish the premorbid maxillary dental arch is important. This was a retrospective study conducted from 2015 to 2020. All patients underwent computed tomography (CT) scan for surgical planning of orthognathic surgery due to either esthetic or occlusion concerns. The classification of occlusion was recorded as class I, II, and III. The parameters measured on CT were the distance between the midpoint of the supra-orbital foramen/notch (IS), mesio-buccal cusp tips (IB), central fossa (IC), palatal cusp tips (IP), and the midpoint of the palatal marginal gingiva (IM) of the bilateral maxillary first molars. The IS was compared with the IB, IC, IP, and IM. The results were analyzed by using one-way repeated measurement analysis of variance.
      Eighty-seven patients (36 men and 51 women) were included in the study. There were 13 patients of class I malocclusion, 8 of class II malocclusion, and 66 of class III malocclusion. The IS was comparable to the IC in all three groups. The IS can predict the IC, regardless of the patient's occlusion, and can be subsequently used to decide the width of maxillary dental arch in panfacial fracture management. Further studies are necessary to obtain more definite results.

      Keywords

      Abbreviations:

      CT (Computed tomography), OGS (Orthognathic surgery)
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