“Paradigm Shift” in Orthognathic Surgery - Occlusion First to Face First

Toshihiko TAKENOBU, DDS, Ph.D., Dr.Med.

 

Professor and Chair

Second Department of Oral and Maxillofacial Surgery

Osaka Dental University, School of Dentistry, 

Osaka

JAPAN

🇯🇵

 

 

The COVID-19 pandemic has made people wear masks. As a result, the number of patients undergoing orthodontic treatment has increased. At the same time, the demand for Orthognathic surgery (OGS) is increasing more than ever.

Japan is the only country in the world where OGS treatment is covered by National Health Insurance. It is natural to cure malocclusion in OGS. Skeletal malocclusion can only be cured by surgery. Therefore, in Japan, skeletal malocclusion is treated as a disease and its treatment is covered by the National Health Insurance.

OGS in Japan is mostly performed at public hospitals or university hospitals, not private clinics. So, if occlusion is improved, is it okay to leave the aesthetics of the face alone? Unfortunately, in public hospitals and university hospitals in Japan, there is a tendency not to consider aesthetic treatments. Furthermore, Japanese oral surgeons tend not to say that I pursue aesthetics.

Even with OGS, there must be some way to pursue aesthetics during surgery. In my lecture this time, I would like to present mandibular contouring, mandibular angle reduction, mental narrowing, asymmetry improvement, and soft tissue touch-up surgery.

By devising a technique in OGS treatment, it should be possible to give further patient satisfaction and happiness.

We oral surgeons don't need to worry about plastic or cosmetic surgeons.

We are in an era of “paradigm shift” from occlusion only to facial esthetics in OGS treatment.

Richard Yuxiong SU

Prof. Richard Yuxiong Su currently works as Professor and Division Chief in Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong. He is an Education Committee member of the International Association of Oral and Maxillofacial Surgeons. He serves as international faculty and Asia Pacific Board member of the AO Craniomaxillofacial Foundation.  He also works as an Associate Editor of Frontiers in Oncology (Head and Neck Cancer Section) and Deputy Editor of Craniomaxillofacial Trauma & Reconstruction.

 

 

Prof. Richard Su’s main research areas include clinical and translational research in oral and maxillofacial oncology, microsurgical reconstruction, and salivary gland diseases, with a special focus on computer-assisted surgery and 3D printing in head and neck reconstruction. He is the lead surgeon of the maxillofacial oncology and microsurgical reconstruction team at the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong.  He has published more than 100 manuscripts in peer-reviewed international journals.  He has lectured extensively in regional and international conferences and courses. Prof. Su is the inventor of seven patents, including two US patents and five China patents. He has been awarded seven peer-reviewed external research grants as the principal investigator. 

Emerging Dilemma in the Treatment of Mandibular Metastasis

 Jehn-Shyun HUANG, DDS, PhD

The incidence of cancer is expected to continue to rise due to the rapid aging of the population and unhealthy lifestyles around the world. Although there is an increasing trend among cancer patients, due to the advancement of new medical technologies such as targeted drugs and immunotherapy, as well as the improvement of cancer care quality, the five-year survival rate for cancer has increased steadily. With the evolution of oncological treatments, which have led to increased survival of cancer patients, the incidence of bone metastases has increased. Besides primary tumors, metastasis causes more cancer death nowadays. Treating metastasis, therefore, remains a challenge. After lung and liver, bone is considered to be the third most common organ involved in metastases.

Oral and maxillofacial surgeons who face oral malignancies every day in their clinics will see oral metastasis in the mouth from other tissue sites more.

The cardinal signs and symptoms include jawbone swelling, facial asymmetry, tooth mobility or exfoliation, gum bleeding, pain, and lower lip paresthesia. The diagnosis will depend on the clinical examination, medical history, X-ray taking, CT or MRI scan, and PET. The definite diagnosis is based on the biopsy and pathological examination. Most metastatic lesions are rich in vascularity and prone to bleeding upon the biopsy procedure.

The treatment modalities—including radical en-bloc surgery, radiation therapy, cytokine therapy, molecular targeted therapy, and administration of anti-bone resorption agents, —seemed to contribute to favorable survival. The goals of the surgical approach are to reduce the pain or neurological deficit, reconstruct the continuity of the skeleton, restore function, and improve the life quality of cancer patients. Some survival prediction assessments, such as the 2013 SPRINGE model, could be applied to evaluate mandibular metastasis, but the effects need to be verified further.

Mandibular metastasis emerged as a dilemma in the treatment of skeletal-related diseases. We presented the preliminary results and experiences in the therapy for metastasis in the jawbone. These two patients with mandibular metastasis survived for more than 5 years after the surgery. The therapeutic modality for mandibular metastasis will be discussed in the presentation.

National Cheng Kung University Hospital Department of Stomatology
Oral and Maxillofacial Division

Dean of the Department of Stomatology Associate Professor of Institute of Oral Medicine Jehn-Shyun HUANG, DDS, PhD

Mario Estavillo ESQUILLO

MARIO ESTAVILLO ESQUILLO DMD

 

 

GRADUATED:  1982, Manila Central University, College of Dentistry.

                                         

EXTERNSHIP TRAINING  in Oral Surgery, University of the Philippines – 

     Philippine General Hospital, 1983.

 

POST GRADUATE in Oral and Maxillofacial Surgery, Tri-Service General 

    Hospital, Taipei, Taiwan, ROC, 1989-1991

 

 

ASSOCIATE  PROFESSOR: Manila Central University, College of  

          Dentistry  

 

CHAIRMAN : Dental and Oral Medicine Department , De Los Santos   

                  Medical Center, Q.C. 

 

SPECIALIST  in OMS by the Professional Regulatory Commission 2015 – 

                               Present 

 

DIPLOMATE and CHAIRMAN: PCOMS Board of Oral and Maxillofacial  

               Surgeons 

 

FELLOW AND PAST PRESIDENT:  Phil. College of Oral and 

             Maxillofacial Surgeons. 1994-1995; 2004-2005

 

FELLOW AND PAST PRESIDENT:  Phil. Academy of Implant   

             Dentistry.2000-2001

 

FELLOW AND COUNCIL MEMBER:  International Association of Oral  

             and Maxillofacial Surgeons,  1998 to present.

                          

FELLOW AND PAST PRESIDENT:  Asian Association of Oral and   

                 Maxillofacial Surgeons

                 

 FELLOW:  International College of Dentists.

 

CHAIRMAN:  Phil. College of Oral and Maxillofacial Surgeons 

                     Board of Regents; 2007- 2011: 2020 - 2022

Computer Aided Surgical Simulation in Orthognathic Surgery- from 2D to 3D Surgical Planning

Henry, Hung-Ying Lin

National Taiwan University

With the advancement of surgical techniques, combined with the advancement of preoperative imaging diagnostic tools and various surgical simulation software, Computer Aided Surgery Simulation (CASS) enables physicians to analyze jaw bone deformity more accurately and plan all the surgical procedures in detail. Meanwhile, we could predict the surgical difficulty, and then transfer the virtual planning to actual operation by using 3D-printed static surgical guides, or dynamic navigation systems. Nowadays, performing precision surgery is the primary goal of every surgeon. In recent years, the oral and maxillofacial surgical team in our hospital has comprehensively used CASS technology in all kinds of surgery, such as orthognathic surgery, congenital deformity of the jaw, reconstruction of jaw fractures, reconstruction of mandibular defects, and also, temporomandibular joint surgery. It not only brings great improvement in the quality and safety of related surgeries but also provides better clinical satisfaction for our patients. At the same time, it significantly helps to expand the global vision of specialist residency training. Thus, the motivation to understand every surgical detail of our residents and trainees was enhanced.

I am honored to have this opportunity to make this presentation and share our experiences over the past years. It is my pleasure to have further interaction with all respectful participants in person after COVID-19 Pandemic. 

 

Gala Dinner

Sky Lounge 

at Level 20

Ambassador Hotel

高雄國賓大飯店

20F 樓外樓 

Cell Therapy in Otorhinolaryngology and Head Neck

 

Tsung-Lin Yang 

MD. Ph.D. EMBA

yangtl@ntu.edu.tw

 

Chief and Professor

Head and Neck Surgery, Department of Otolaryngology

National Taiwan University Hospital

 

Cell therapy was predominantly initiated by bone marrow transplantation decades ago. However, the application of cells for regenerative medicine and clinical treatment faced huge challenges in the translation from bench to bedside during the early stages of development. An exponential growth in experimental therapies has occurred in the past decade, majorly focusing on cancer therapy and regenerative medicine. The therapeutic scopes extend from improving clinical efficacy for incurable diseases to the innovation of novel clinical management. The widely different outcomes emerge not only because of the disease entity but also the therapeutic resources that are applied. Otorhinolaryngology enrolls head and neck surgery in various tissues. Conventional management for tissue injury in otorhinolaryngology and head and neck encompass transplantation and graft of tissue or artificial materials. Because of their limited availability, regenerative medicine, including cell therapy and tissue engineering, develops rapidly. The clinical-grade procedures are required to be followed during the preparation, particularly for those cells with distinct origins. In addition, new therapies expose new risks to clinical practice, which are difficult to be predicted and managed because of lacking knowledge and experience. This discrepancy between the expectations of the patients and clinical outcomes may be inflated, and the clinic results may desperate patients. The method of cell introduction and preparation quality is related to the final outcome in the therapeutic effects. Therefore, understanding the agents that will be used in cell therapy is an important issue that poses an emerging requirement for the physicians who will be engaged in cell therapy for expected progress. 

Chieh-Yuan CHENG

鄭介原

現職:                                       

n  馬偕紀念醫院口腔顎面外科主治醫師

n  馬偕醫學院醫學系助理教授

n  中華民國口腔顎面外科醫學會理事

 

主要學歷:

n  台北醫學大學牙醫系學士

n  國立陽明大學牙醫系碩士

n  國立台北科技大學生物科技博士

 

主要經歷:

n  馬偕醫學院醫學系助理教授

n  國立陽明大學牙醫系講師

n  台北醫學大學牙醫系講師

n  馬偕紀念醫院口腔顎面外科主任

n  中華民國口腔顎面外科醫學會理事、監事

n  美國西雅圖華盛頓大學醫學中心(UWMC)頭頸外科臨床研究

n  美國福瑞德哈金森腫瘤研究中心(Fred Hutchinson Cancer Research Center)研究員

 

專長:

n   口腔癌及口腔良性腫瘤手術

n   正顎手術及顏面削骨手術

n   顏面骨折手術

n   唾液腺內視鏡手術

n   顳顎關節手術

n   人工植牙及齒槽骨重建手術

 

期刊論文

 

1.        Sing-You Chen, Yung-Hsin Cheng, Yung-Yun Cheng, Kuan-Ju Lee, Li-Han Lin, Chung-Ji Liu, Chieh-Yuan Cheng A Comparison of Clinicopathological Differences and Survival Rates in Oral Squamous Cell Carcinoma between Middle Age and Old Age in Taiwan. International Journal of Gerontology 16 (2022) 39-45 

2.        Chieh-Yuan Cheng, Fang-Ju Sun, Chung-Ji Liu (2020, Jun). The influence of cervical lymph node number of neck dissection on the prognosis of the early oral cancer patients. Journal of Dental Sciences.

3.        Nai-Wen Su, Kaun-Jer Tsai, Yi-Shing Leu, Jehn-Chuan Lee, Chung-Ji Liu, Chieh-Yuan Cheng, Jiun-Sheng Lin, Yu-Jen Chen, Shih-Hua Liu, Chun-How Chen, Yi-Fang Chang (2020, Jan). Modified 3-weekly cisplatin or cisplatin-5-fluorouracil 5-day infusion as the concurrent chemoradiotherapy regimen in locally advanced squamous cell carcinoma of the head and neck: Comparison of efficacy and toxicity. Journal of Cancer Research and Practice , 7(1):17.

4.        Cheng CY, Fang HW (2018, Apr). Old age lower lip cancer defects reconstruction by Abbe-Estlander flap. International Journal of Gerontology, 12:160-163. 

5.        Cheng CY, Liu CJ, Huang YC, Wu SH, Fang HW, Chen YJ (2018, Apr). BI2536 induces mitotic catastrophe and radiosensitization in human oral cancer cells. Oncotarget, 9:21231-21243. 

What Weapons Are Available in the Face of Sialolithiasis?

鄭介原 Chieh-Yuan CHENG

Sialolithiasis is a common oral salivary gland disease. Most of the clinical manifestations are painless, and more than 20 % of sialolithiasis displayed radiolucency in plain films. 

Different surgical methods are often used because of the size, location, and shape of the stones, which make diagnosis more important to be determined. 

Conservative treatments include sialogogues, massage, heat, and antibiotic therapy. But these approaches are usually ineffective. However, the traditional surgical method has its limitations, including the location of sialolithiasis, and possible complications of nerve damage. Therefore, we need more weapons available in the face of sialolithiasis. 

The diagnosis and location of sialolithiasis to be investigated by head and neck ultrasound, and the use of sialaendoscopy provides a better treatment for sialolithiasis and reduces the occurrence of complications. Because this operation requires extensive experience and expensive equipment, this speech will provide more information for your reference. 

 

 

Current Status Boron Neutron Capture Therapy for Head and Neck Cancer

Kazuyo IGAWA

井川　和代

 

Neutron Therapy Research Center, Okayama University, Okayama, Japan

In recent years, high-precision radiotherapy for cancer has been established with the development of therapeutic equipment that generates various types of radiation, such as X-rays, proton beams, heavy particle beams, and neutron beams, as well as radiation irradiation methods to reduce the dose of radiation to surrounding normal tissues. As one of the radiation therapies, Boron neutron capture therapy (BNCT) is expected to improve treatment outcomes and reduce side effects. BNCT is a unique binary therapy based on the idea of selectively delivering boron compounds into tumour tissue, which is subsequently irradiated with neutrons. These neutrons are captured by boron, which is followed by the emission of alpha particles and recoil of the lithium nucleus, both with very high energy transfer within extremely short stopping distances, comparable to the size of a single cell. Both the intracellular high biological effectiveness and strictly localized tumour cell damage at the cellular level are the major advantages of BNCT in clinical therapy.

Since 1951, BNCT has been performed mainly at research reactors, and in the last two decades, more than 1000 patients worldwide have been treated at these facilities and significant progress. However, many of these reactors have been shut down or have discontinued their BNCT-related activities, in particular, due to the difficulty of combining a reactor environment with clinical requirements. Presently only four reactors continue to offer BNCT as a possible cancer treatment, including Tsing Hua open-pool reactor (THOR) in Taiwan.

The first reactor-based BNCT for head and neck cancer was conducted by an oral maxillofacial surgeon, Dr. Kato, Osaka University, in 2001. Instead of reactor-based BNCT, the accelerator-based BNCT for head and neck cancer was approved in Japan in 2020, then over 100 head and neck cancer patients were treated at Osaka Medical and Pharmaceutical University, Osaka, and Southern Tohoku Hospital, Fukushima. I will introduce you to the current status of BNCT worldwide. 

Clinical Practice Guidelines and Modern Management Approaches for Craniofacial Fibrous Dysplasia

Professor Shiao-Pieng LEE

Tri-Service General Hospital

National Defense Medical Center

 

Fibrous dysplasia (FD) is one of the most perplexing diseases of osseous tissue caused by post-zygotic, activating mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and immature woven bone. FD comprises approximately 2.5% of all bone tumors and nearly 7.5% of benign bone pathology. It is more common in children and young adults with equal gender predilection.

 

FD frequently affects the craniofacial complex, including the maxilla and the mandible. This benign tumor-like condition can cause a variety of signs and symptoms depending on the extensive type and specific location of the lesions. The most common presenting features included facial deformity, malocclusion, intraoral bulging, and dental anomalies. There is no consensus regarding the best surgical treatment (conservative or radical) for craniofacial FD. The prognosis for patients with craniofacial FD is usually favorable, although the spontaneous malignant transformation is reported.

 

The rarity of craniofacial FD, its variable clinical behavior, and progression often leads to misdiagnosis and inadequate therapeutic approaches, thereby making treating this condition difficult with few established guidelines for clinicians. Accordingly, this talk is mainly aimed at a comprehensive review of the current concept, recent developments, and modern management of this disease and the sharing of experience in TSGH. I will then suggest the clinical practice guidelines for craniofacial FD that are tailored to the individual patient and founded on clinical, radiological, and pathoanatomical information. 

Clinical Applications of Head and Neck Ultrasound 

Hsin-Hui PENG

Hsin-Chu Branch

National Taiwan University Hospital

Ultrasound is one of the most commonly used imaging tools in the head and neck region. Head and neck ultrasound can be used as a diagnostic and procedure tool, including examination of neck lymph node, salivary gland tumor and stone, unknown head and neck mass, core needle biopsy, fine needle aspiration, etc. With the development of the machine and technology, ultrasonic machines have significantly improved in size, weight, and portability, and can maintain good image quality. I hope to share our experience of using head and neck ultrasound in NTUH Hsin-Chu Branch and share the learning process of head and neck ultrasound as an oral and maxillofacial surgeon. I look forward to more oral and maxillofacial surgeons entering the field of head and neck ultrasound together.

 

 

Lee-Shuan LIN 

DVM, MA, PhD

林  莉萱 副教授

Tel: +886-8-7703202-5059

Email: lslin@mail.npust.edu.tw

Associate Professor, National Pingtung University of Science and Technology (NPUST), Pingtung, Taiwan

Education 

2001  National Taiwan University, Department of Veterinary Medicine, DVM.

2003  Taipei Medical University, Graduate Institute of Medical Sciences, MA.

2013  University of Tokyo, Doctoral course of Veterinary Medicine, Ph.D.

 

Working Experience

2006-2006  Clinical Veterinarian, domestic animal hospital

2006-2008  Clinical Veterinarian, National Taiwan University 

2013-2020  Assistant Professor, Department of Veterinary Medicine, NPUST

2013-      Director of Diagnostic Imaging, Veterinary Medical Teaching Hospital, NPUST

2020-      Associate Professor, Department of Veterinary Medicine, NPUST

2021-      Jointly Appointed Associate Professor, School of Dentistry, College of    Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, 

2021-      Jointly Appointed Associate Professor, Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

 

Expertise

Veterinary Radiology (XR, US, CT, MRI, NM)
Veterinary Endoscopy
Application of 3D Printing in Companion Animals

 

Publish

1.     Hsu TC, Lin LS, Chung CS, Chiang C, Chiu HC, Huang PH. 2022 June 17. Colonic Intramural Hematoma in a Cat: A Case Report. Front Vet Sci 9:913862. (SCI) (Correspondence)

2.     Chang CC, Wechtaisong W, Chen SY, Cheng MC, Chung CS, Lin LS, Lien YY, Tsai YL. 2022, June 13; Prevalence and Risk Factors of Zoonotic Dermatophyte Infection in Pet Rabbits in Northern Taiwan. J. Fungi. 8(6), 627. (SCI) 

3.     Chang YS, Chiang C, Shih CH, Lin LS. 2022, May 18; Pathology in Practice. J Am Vet Med Assoc. 259(S2): 1-3 (SCI) (Correspondence)

4.     Jaffey JA, Kreisler R, Shumway K, Lee YJ, Lin CH, Durocher-Babek LL, Seo KW, Choi H, Nakashima K, Harada H, Kanemoto H, Lin LS. 2022, Feb; Ultrasonographic patterns, clinical findings, and prognostic variables in dogs from Asia with gallbladder mucocele. J Vet Intern Med. (SCI)

5.     Chiang C, Chen KS, Chiu HC, Chung CS, Lin LS. 2022, Feb 1; Computed Tomography Lymphangiography via Intrametatarsal Pad injection is Feasible in Cats with Chylothorax. Am J Vet Res. 83(2); 133-139. (SCI)(Correspondence)

6.     Lin LS, Teo YM, Chung CS. 2021 Nov 25. Case Report: Treatment of Femoral Non-union with Rib and Iliac Crest Autografts and rhBMP-2 in a Cat. Front Vet Sci 8:756167. (SCI) (Co-fist author)

7.     Kuo YW, Lin LS, Li YC, Chen KS. 2021 Jul 22; Thoracic Radiographic Features of Fatal Paraquat intoxication in Eleven Dogs. Vet Q. 41:1, 217-225 (SCI)

8.     Chung CS, Li YC, Lin LS. 2020 Dec; Radiographic Findings and Pathology of a Dog with Mercury Toxicity. Forensic Imaging. 23, 200421 (ESCI) (Correspondence)

9.     Chen PH, Chung CM, Wang YY, Huang HW, Huang B, Lee KW, Yuan SH, Wu CW, Lin LS, Chan LP. 2020 Nov 21; CYP26A1 is a Novel Biomarker for Betel Quid-related Oral and Pharyngeal Cancers. Diagnostics. 10, 982. (SCI)

10.  Tanaka T, Nishida H, Mie K, Yamazaki H, Lin LS, Akiyoshi H. 2020 Aug 3; Assessment of Hepatitis and Fibrosis Using Gd-EOB-DTPA MRI in Dogs. Vet Rec Open. 7(1):e000371 (ESCI)

11.  Lin LS, Chung CS. 2020 July; Novel Contrast Agent Visphere is Feasible for Contrast-enhanced Ultrasonography in Dogs. Vet Radiol Ultrasound. 61(4):461-470 (SCI) (Fist author/ Correspondence)

 

12.  Lin LS, Chiu HC, Nishimura R, Fujiwara R, Chung CS. 2020 July; Computed Tomographic Lymphangiography via Intra-metatarsal Pad Injection is Feasible in Dogs with Chylothorax. Vet Radiol Ultrasound. 61(4):436-443 (SCI) (Fist author/ Correspondence)

13.  Tu YJ, Chung CS, Lin LS. 2020 Apr; Using Sildenafil to Treat a Dog with Idiopathic Megaesophagus. Taiwan Vet J. 46 (1):1-6 (Correspondence)

14.  Tanaka T, Akiyoshi H, Nishida H, Mie K, Lin LS, Iimori Y, Okamoto M. 2019 Nov 22; Contrast-enhanced Computed Tomography Findings of Canine Primary Renal Tumors Including Renal Cell Carcinoma, Lymphoma, and Hemangiosarcoma. PLoS ONE. 14(11):e0225211. (SCI)

15.  Hsu HS, Lin TH, Wu HY, Lin LS, Chung CS, Chiou MT, Lin CN. 2016 Jun; High Detection Rate of Dog Circovirus in Diarrheal Dogs. BMC Vet Res. 12(1):116 (SCI)

16.  Lin LS, Kayasuga-Kariya Y, Nakamura S, Shimohata N, Sakai T, Fujisawa A, Akagi Y, Suzuki S, Chung UI, Sasaki N, Mochizuki M. 2016 Aug; Co-lyophilized Aspirin with Trehalose Causes Less Injury to Human Gastric Cells and Gastric Mucosa of Rats. Dig Dis Sci. 61(8):2242-51 (SCI) (Fist author)

17.  Choisunirachon N, Lin LS, Tanaka Y, Saeki K, Fujiwara R, Nishimura R, Nakagawa T. 2014 Dec; Retrospective Study of Computed Tomographic Characterization of Canine Oral Malignant Melanoma in 24 Dogs. Thai J Vet Med. 44(4):497-503 (SCI)

18.  Kayasuga-Kariya Y, Iwanaga S, Fujisawa A, Lin LS, Suzuki S, Chung UI, Sasaki N, Shimohata N, Mochizuki M. 2013 Dec; Dermal Cell Death Induced by Topical Application of Non-steroidal Anti-inflammatory Drugs is Suppressed by Trehalose in Ex Vivo Analysis. J Vet Med Sci. 30;75(12):1619-22 (SCI)

19.  Lin LS, Kayasuga Y, Shimohata N, Kamata H, Suzuki S, Echigo R, Mochizuki M, Chung UI, Sasaki N. 2012 Nov; Lyophilized Aspirin with Trehalose may Decrease the Incidence of Gastric Injuries in Healthy Dogs. J Vet Med Sci. 74(11):1511-6 (SCI) (Fist author)

 

Patent

1.     放射影像攝影設備及其操作方法2022年(中華民國專利發明第I774163號)

2.     3D列印動物植入型義肢2019年 (中華民國專利發明第I675650號)

3.     非接觸式紅外線體溫量測系統2017年(中華民國專利新型第M543673號)