Korean J Orthod.  2024 Mar;54(2):89-107. 10.4041/kjod23.194.

Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis

• Kim YJ
• Kim MY
• Jha N
• Jung MH
• Kwon YD
• Shin HG
• Ko MJ
• Jun SH

• KMID: 2554366
• DOI: http://doi.org/10.4041/kjod23.194

Abstract

Objective
This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery.
Methods
The primary objective was to address the question, “How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?” A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung–Knapp–Sidik–Jonkman method for randomeffects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D).
Results
Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up.
Conclusions
Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

Keyword

Facial asymmetry; Orthognathic surgery; Temporomandibular joint disorder; Surgical stability

Figure

• 

  Figure 1 PRISMA flowchart to screen and identify the included studies.

• 

  Figure 2 Skeletal symmetry improvement: one-jaw vs. two-jaw (study groups and outcomes are shown in Table 3). SD, standard deviation; FU, follow-up; SMD, standardized mean difference; CI, confidence interval, HK, Hoffman and Kringle.

• 

  Figure 3 Forest plot for dental midline discrepancies between upper and lower arches (A), lower dental midline discrepancies (B), and upper dental midline discrepancies (C) (study groups and outcomes are shown in Table 3). SD, standard deviation; FU, follow-up; SMD, standardized mean difference; CI, confidence interval, HK, Hoffman and Kringle.

• 

  Figure 4 Forest plot for lip canting (study groups and outcomes are shown in Table 3). SD, standard deviation; FU, follow-up; SMD, standardized mean difference; CI, confidence interval, HK, Hoffman and Kringle.

• 

  Figure 5 Skeletal symmetry based on different follow-up periods (study groups and outcomes are shown in Table 3). SD, standard deviation; FU, follow-up; SMD, standardized mean difference; CI, confidence interval, HK, Hoffman and Kringle.

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