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Computer guided maxillo-malar piezoelectric osteotomies for midface augmentation

  • Author Footnotes
    # Andrea Lazzarotto and Alessandro Tel have equally contributed to the final manuscript and should therefore be both considered as co-first authors.
    Andrea Lazzarotto
    Footnotes
    # Andrea Lazzarotto and Alessandro Tel have equally contributed to the final manuscript and should therefore be both considered as co-first authors.
    Affiliations
    Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
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  • Author Footnotes
    # Andrea Lazzarotto and Alessandro Tel have equally contributed to the final manuscript and should therefore be both considered as co-first authors.
    Alessandro Tel
    Footnotes
    # Andrea Lazzarotto and Alessandro Tel have equally contributed to the final manuscript and should therefore be both considered as co-first authors.
    Affiliations
    Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
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  • Serena Brontoladi
    Affiliations
    Maxillofacial and Plastic Surgery Department, Hospital Necker Enfants Malades, 149 Rue de Sevres, 75015, Paris, France
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  • Salvatore Sembronio
    Affiliations
    Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
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  • Fabio Costa
    Affiliations
    Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
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  • Massimo Robiony
    Correspondence
    Corresponding author.
    Affiliations
    Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
    Search for articles by this author
  • Author Footnotes
    # Andrea Lazzarotto and Alessandro Tel have equally contributed to the final manuscript and should therefore be both considered as co-first authors.
Published:October 19, 2022DOI:https://doi.org/10.1016/j.bjps.2022.10.040

      Summary

      Purpose

      Despite maxillo-malar osteotomies having been discarded in the most recent literature, in the setting of orthognathic surgery they provide several advantages for middle third augmentation. This paper reintroduces maxillo-malar osteotomies as an effective method to increase volume of midfacial region in combination with contemporary technology, including piezosurgery, virtual surgical planning, and navigation.

      Material and Methods

      Eighteen patients with midface hypoplasia were included in this study and underwent orthognathic surgery with maxillo-malar osteotomies. All patients underwent the same workflow: virtual design of maxillo-malar osteotomies, surgery with navigation-assisted piezoelectric osteotomies, and computerized morphometric analysis.

      Results

      Simulated maxillo-malar osteotomies were successfully replicated in the operating room, as shown by accuracy evaluation performed using three-dimensional analysis. In long-term follow-up period, no permanent complications were assessed. Superimposition between postoperative and preoperative CBCTs revealed that the soft tissue area influenced by the underlying skeletal movement was comparable for all cases.

      Conclusions

      Virtual surgical planning, navigation, and piezosurgery are today indispensable tools to perform maxillo-malar osteotomies safely and accurately. We suggest incorporating such osteotomies in the surgeon's armamentarium for patients with severe midfacial hypoplasia as they offer an integrated solution to restore functionality and aesthetics.

      Keywords

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