Surgical Navigation in Oral and Maxillofacial Surgery

Tong-Nien HSU

   Surgical navigation has become an increasingly valuable technology in oral and maxillofacial surgery, providing real-time spatial guidance by integrating preoperative imaging, virtual surgical planning, and intraoperative instrument tracking. Similar to a GPS system, navigation allows surgeons to continuously identify the position of surgical instruments in relation to the patient’s three-dimensional anatomy and the preoperative plan.

Its applications have expanded from anatomical localization to guidance, execution, and verification in various maxillofacial procedures, including trauma surgery, tumor resection, orthognathic surgery, and complex osteotomy. In maxillofacial trauma, navigation combined with intraoperative imaging enables objective assessment of fracture reduction, orbital reconstruction, and skeletal symmetry, allowing immediate correction when discrepancies are detected. Navigation-guided osteotomy further translates virtual surgical planning into real-time surgical execution by providing information on cutting position, orientation, and depth while helping surgeons avoid critical anatomical structures.

    Despite limitations related to registration accuracy, anatomical movement, workflow complexity, and cost, surgical navigation continues to evolve beyond simply showing “where we are.” By connecting planning, guidance, verification, and intraoperative adaptation, navigation serves as a surgeon’s “third eye,” enhancing precision, confidence, and predictability in oral and maxillofacial surgery.

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Speakers

International Speakers

Firdaus HARIRI 

Muhammad Kamil Bin HASSAN

Dae Seok HWANG

Kazuyo IGAWA

Boosana KABOOSAYA

Yong-Deok KIM

Jae-Yeol LEE

Keiichiro MIURA

Jay De OCAMPO

Jun-Young PAENG

Joo-Young PARK

Jimson SAMSON

Tian Ee SEAH

Richard Yu-Xiong SU

Kei TOMIHARA

Domestic Speakers

Yu-Hsin CHANG

Michael Yuanchien CHEN

Philip Kuo-Ting CHEN

Yu-Feng CHEN

Chih-Sheng CHENG

Elliot Shih-Jing CHENG

Han-Chieh CHENG

Han-Jen HSU

Po-Chih HSU

Tung-Nien HSU

Anthony Shou-Yen KAO

Edward Chengchuan KO

Arthur Yen-Hung LIN

Howard Han-Wei LIN

Hung-Ying LIN

Yi-Feng LIN

Wen-Liang LO

Ming-Yi LU

Chihyu PENG

Chang-Wei SU

Cheng-Hsi TSAI

Louisa Hsin-Yi TSOU

Ling-Ying WEI

Chia-Yu WU

Cheng-Hsien WU

Tsung-Lin YANG

Free Paper

A KMU Legacy in Orthognathic Surgery: Thousands of Vertical Ramus Osteotomies Across Generations

Han-Jen HSU

      While bilateral sagittal split osteotomy (BSSO) remains the predominant worldwide technique for mandibular orthognathic surgery, intraoral vertical ramus osteotomy (IVRO) offers profound biological and anatomical benefits. This study shares Kaohsiung Medical University’s (KMU) multi-decade experience across thousands of consecutive IVRO cases, focusing on surgical refinement, condylar adaptation, and clinical risk mitigation in both functional-prosthetic and aesthetic cohorts.

      Over three decades, standardized IVRO protocols were systematically developed, transitioning from analog instrumentation to contemporary 3D virtual surgical planning (VSP) and CAD/CAM splints. Patients underwent short-term intermaxillary fixation followed by guided elastic mobilization. Longitudinal outcomes—including inferior alveolar nerve (IAN) neurosensory function, temporomandibular joint (TMJ) symptoms, skeletal stability, and patient-reported satisfaction—were evaluated.

      In our longitudinal series of over thousands of cases, IVRO demonstrated exceptional anatomical safety, with no permanent IAN paresthesia occurring. Individuals presenting with pre-existing TMJ arthralgia or internal derangement experienced marked clinical relief through physiologic condylar decompression without torque. Long-term skeletal stability was maintained even in extreme setbacks (>10 mm), showing reliable Wolff’s law remodeling. In prosthetically driven reconstructions, IVRO established a harmonious vertical dimension for subsequent rehabilitation without dentoalveolar strain. Crucially, in high-demand aesthetic cohorts where psychological vulnerability is elevated, eliminating permanent neurosensory deficits significantly minimized postoperative dissatisfaction and medicolegal conflict.

       IVRO is far from an obsolete procedure; rather, it represents a sophisticated, biologically driven technique. Combining modern digital planning with standardized execution, IVRO ensures unmatched nerve preservation, physiological condylar seating, and unparalleled peace of mind in aesthetic and reconstructive orthognathic surgery.

From Surgical Outcomes to Functional Recovery: Rethinking Success in Oral and Maxillofacial Surgery

Boosana KABOOSAYA 

Advances in oral and maxillofacial surgery have significantly improved surgical precision, anatomical reconstruction, and treatment outcomes. Traditionally, surgical success has been evaluated through wound healing, complication rates, anatomical restoration, and long-term treatment survival. However, favorable surgical outcomes do not necessarily translate into complete functional recovery. Patients may continue to experience difficulties with mastication, swallowing, speech, and other essential oral functions despite satisfactory surgical results.

This lecture highlights the importance of expanding the definition of surgical success beyond technical and anatomical outcomes to include functional recovery and patient-centered perspectives. It explores the role of functional assessment, early intervention, and rehabilitation in optimizing postoperative recovery and improving patients’ quality of life.

Looking ahead, integrating functional outcomes into routine surgical practice may support more comprehensive treatment planning and individualized patient care. Ultimately, the future of oral and maxillofacial surgery lies not only in achieving surgical excellence but also in restoring meaningful daily function.

Looking Beyond the Surgery for the Treatment of Locally Advanced Oral Cancer

Po-Chih HSU

    Locally Advanced Oral Squamous Cell Carcinoma (OSCC) presents significant clinical challenges due to high recurrence rates and distant metastatic potential, often leading to suboptimal outcomes when managed by conventional surgery alone. The Oral and Maxillofacial Surgery team at Taipei Tzu Chi Hospital has been actively working to extend treatment boundaries beyond surgical resection by refining multimodal therapeutic strategies for advanced OSCC.

    Historically, Taipei Tzu Chi Hospital established a primary treatment protocol integrating Induction Chemotherapy (ICT) with surgery for locally advanced cases. Long-term clinical follow-up demonstrated that pre-operative ICT effectively shrinks and downstages primary tumors, yielding a significant extension in mean overall survival and disease-free survival.

    Expanding on these systemic therapy insights, Taipei Tzu Chi Hospital successfully incorporated neoadjuvant immunotherapy into its Multidisciplinary Team (MDT) clinical care pathway. Recent clinical evidence confirms that for high-burden, complex cases (such as Stage IVA/IVB, cT4b, or extensive cervical nodal disease), neoadjuvant IO delivers profound tumor regression and dramatic pathological downstaging, frequently achieving a pathological complete response or a minimal residual disease footprint.

    Embracing the vision of "Looking Beyond the Surgery," this combined pre-operative immunotherapy and precision surgical approach optimizes organ function, minimizes post-operative recurrence risk, elevates long-term survival, and opens critical windows for curative-intent surgery in previously unresectable tumors.

From Scalpel to Artificial Intelligence: A Surgeon's Journey Through Clinical Care, Research, and Education

Elliot Shih-Jung CHENG

Oral and maxillofacial surgery has evolved remarkably through advances in precision medicine, digital technology, and artificial intelligence (AI). As an oral and maxillofacial surgeon, clinician-scientist, and educator, my professional journey reflects the integration of clinical practice, translational research, and medical education to improve patient care.

    In clinical practice, the management of oral cancer and complex maxillofacial conditions has advanced through multidisciplinary collaboration and innovative surgical technologies. Virtual surgical planning, computer-assisted navigation, three-dimensional printing, and patient-specific implants have enhanced surgical precision and functional outcomes. The "Jaw-in-a-Day" approach, integrating tumor resection, immediate reconstruction, dental implantation, and prosthetic rehabilitation, exemplifies the transformation toward comprehensive, patient-centered care.

    In translational research, my work has focused on the molecular mechanisms of oral squamous cell carcinoma, particularly epigenetic alterations, cancer stemness, tumor microenvironment interactions, and immune evasion. Bridging laboratory discoveries with clinical observations provides opportunities to identify novel biomarkers and therapeutic strategies.

    In education, cultivating critical thinking, surgical competence, scientific curiosity, and interdisciplinary collaboration remains essential. Emerging technologies, including digital simulation and AI-assisted learning, offer new possibilities for training future healthcare professionals.

    Looking ahead, AI will increasingly support diagnosis, surgical planning, risk prediction, and personalized treatment. However, technological innovation must complement rather than replace clinical judgment, surgical expertise, and compassionate care.

 

    Ultimately, this journey from scalpel to artificial intelligence emphasizes the importance of integrating clinical excellence, scientific discovery, and education to advance patient outcomes and inspire future generations of clinician-scientists.

Chihyu PENG

Chih-Yu PENG 

Business Address: Department of Oral and Maxillofacial Surgery, Chung Shan Medical University Hospital, No. 110, Sec. 1 Jiankuo-Kuo N. Road, Taichung, 403, Taiwan 

Tel: 886-4-24718668 ext 55143

E-mail: cyp@csmu.edu.tw

Nationality: Taiwanese

 

Education

DDS, Kaohsiung Medical University, School of Dentistry 

MDS., Chung Shan Medical University, College of Oral Medicine, School of Dentistry

PhD., Chung Shan Medical University, College of Oral Medicine, School of Dentistry

 

Current Position

Professor, Chung Shan Medical University, College of Oral Medicine, School of Dentistry

Chairman, Department of Oral and Maxillofacial Surgery, Chung Shan Medical University Hospital

Clinical professor, Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, School of dentistry

 

Membership in professional organization

Member and specialist of Taiwan Association of Oral and Maxillofacial Surgeons

Member and specialist of Taiwan Head and Neck Society

Member of Committee of Taiwan Association of Oral and Maxillofacial Surgeons Board

Member and specialist of Academy of Dental Implantology, Republic of China

Member and specialist of Taiwan Academy of Implant Dentistry

Member of the Committee of the Taiwan Academy of Implant Dentistry Board

Consultant, Taiwan Cancer Society

Tumor Satellite Budding: A Hallmark of the Biological Basis of Aggressiveness in Head and Neck Cancer

 

Tsung-Lin Yang MD. PhD. EMBA.^1,2,3*

 

¹Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

²Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

³Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan

Abstract

Tumor satellite budding—the detachment of single cells or small clusters from the primary tumor front—represents an early and clinically significant step in the invasion–metastasis cascade of head and neck squamous cell carcinoma (HNSCC). Although its prognostic value was first established through our pathological analyses, the mechanisms that determine when and how these seeds leave the tumor mass have remained difficult to capture, because conventional pathology provides only a static snapshot of an inherently dynamic process. To address this limitation, we developed a biomimetic 3D modeling platform that enables real-time visualization of tumor satellite budding and systematic dissection of the microenvironmental niche factors that shape it. Using this system, we showed that hypoxia suppresses both the incidence and the migratory distance of HNSCC tumor satellites; this effect is mediated by reduced nuclear translocation of the intracellular domain of E-cadherin and β-catenin, thereby linking a core adhesion/signaling axis to oxygen-sensing pathways at the invasive front. Building on these findings, we are now extending the model to define the differential contributions of HIF-1α and HIF-2α—including their spatial distribution across tumor compartments—to satellite formation and budding behavior, integrating omics profiling with in vivo pathological validation. Collectively, these results position tumor satellite budding as both a mechanistic readout of niche-driven tumor plasticity and a potential biomarker of aggressiveness in HNSCC, with implications for risk stratification and for therapeutic strategies aimed at intercepting dissemination before it becomes clinical metastasis.

Author for correspondence

Tsung-Lin Yang MD. PhD. EMBA

E-mail: yangtl@ntu.edu.tw

#1, Sec. 1 Jen-Ai Road, Taipei 100, Taiwan

Tel: +886-2-23123456 ext. 63526

Fax: +886-2-23940049 

From Bench to Bone: Clinical Translation of BONARC in Oral and Maxillofacial Regeneration

Keiichiro MIURA

Reconstruction of oral and maxillofacial bone defects remains challenging. Although autologous bone grafting is widely used, donor-site morbidity and limitations in the amount of available bone have prompted the search for alternative regenerative materials. This clinical need has guided our work on octacalcium phosphate collagen composite (OCP/Col; BONARC®), from preclinical investigation to clinical application.

OCP/Col combines the osteoconductive properties of octacalcium phosphate with a collagen matrix that supports cell attachment and proliferation. Preclinical studies have explored its potential to promote bone formation and provided the rationale for its clinical evaluation. We have translated this work to patients undergoing Le Fort I osteotomy, where the material is used to support regeneration in postoperative bone defects.

This presentation will describe the translational pathway from material development and preclinical evaluation to clinical study, including the assessment of safety, radiographic bone formation over time, and histological findings obtained during plate removal. It will also discuss the practical and regulatory considerations involved in bringing a regenerative material from the laboratory into clinical practice.

By connecting fundamental research with a clearly defined surgical need, this work aims to evaluate the role of BONARC in oral and maxillofacial bone regeneration and to identify the questions that should guide future clinical research.

Orthognathic Surgery ~ Pearls That I Cherished

 

Michael Yuanchien CHEN,  DDS. MS.

 

Over consecutive three decades of practicing orthognathic surgery, to be honest, there’re a lot of sweet yet occasional sour experiences or outcomes in my hands. I’d like to share with you the best and the worst of them, both of which have been and will be the most precious collections of my own career, and perhaps kind of  lessons for inexperienced young surgeons who are interested in this field.

 

The first part of my presentation focuses on a friendly protocol of practicing orthognathic surgery that I’ve been applying for more than 700 cases since 2014. Thanks to the computer-aid virtual planning software, individualized CAD/CAM surgical guides and ultrasonic bone cutting, grinding instruments, we’re able to make the surgery efficient enough, precise enough with significant enhancement on patient safety and recovery (ERAS), lessening blood loss and days of hospital staying. In other words, it’s a friendly protocol for patients, trainees and surgeons ourselves.

 

The second part will be introduced by showing some of the troubles I’ve met including rupture of major neurovascular bundles, post-operative nasal tip deviation, subcutaneous emphysema and an extremely rare intraoperative severe bad split during bilateral SSRO…etc. Thereafter, pertinent reflections and recommendations will be discussed accordingly. Hopefully, all of the above scenarios would never happen again. It’s impossible and unrealistic to expect a surgeon making no mistake at all, nevertheless, being able to salvage complications doesn’t mean we’re much more respectable.

Survival Outcomes of Metastatic and Recurrent Oral Squamous Cell Carcinoma: A Single-Institution Real-World Experience

ChiSheng CHENG

Recurrence/Metastasis remain the dominant and least tractable pattern of failure in oral cavity squamous cell carcinoma (OCSCC). We analyzed two decades of real-world data to define post-recurrence survival (PRS), identify independent prognostic factors, and derive research and training priorities. We studied 1234 consecutive patients with recurrent or metastatic OCSCC treated at a single institution between 2006 and 2025. PRS was measured from the date of recurrence or metastasis (T0) to death or last follow-up. We tested 12 candidate factors using Kaplan-Meier estimation with log-rank testing and Cox proportional hazards regression with Efron correction for tied event times; factors with univariate p < 0.10 entered a multivariate model. Post-recurrence survival after recurrence or metastasis of OCSCC has not improved over two decades. Operability and resectability remain the principal treatment-related determinants of outcome, whereas ICI and targeted therapy have not yet assumed a major role in this setting. Further gains are unlikely to come from surgical technique alone and will depend on a deeper understanding of recurrence biology. Accordingly, residency training should expand to include the tumor microenvironment, tumor immunology, and biomarker-driven decision-making, so that head and neck surgeons become experts in personalized medicine as well as operative surgery.

Louisa Hsin-Yi TSOU

Attending Surgeon, Division of Oral and Maxillofacial Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital

 

Attending Surgeon / Attending Dentist, Department of Dentistry, Kaohsiung Municipal Siaogang Hospital

 

Board-Certified Specialist in Oral and Maxillofacial Surgery, Ministry of Health and Welfare (MOHW), Taiwan

 

Chief Resident, Division of Oral and Maxillofacial Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital

 

Chief Resident, Division of Oral and Maxillofacial Surgery, Changhua Christian Hospital

 

Resident, Division of Oral and Maxillofacial Surgery & Department of General Dentistry, Chi Mei Medical Center

 

DDS (or BDS), School of Dentistry, Chung Shan Medical University

The Pitiful of SSO: The Route of A Beginner

 Louisa Hsin-Yi TSOU

Bilateral sagittal split osteotomy (BSSO) remains a cornerstone of orthognathic surgery, yet it carries notable risks. This lecture reviews critical intraoperative and postoperative pitfalls, including bad splits, inferior alveolar nerve injury, condylar sag, and skeletal relapse. Practical surgical pearls and clinical troubleshooting strategies are highlighted to optimize outcomes and minimize surgical complications.

Ming-Yi LU

E-mail: miexyz@gmail.com

Nationality: Taiwanese

 

Education:

PhD, School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan 

MDS, School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan 

MDS, School of Stomatology, Wuhan University, Wuhan, China

DDS, School of Dentistry, Chung Shan Medical University, Taichung, Taiwan

 

Current position:

Associate professor, School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan

Attending physician, Department of Oral and Maxillofacial Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan

 

Membership in professional organization

Specialist, Oral and Maxillofacial Surgery, Ministry of Health and Welfare, Taiwan

Executive director, Board of Taiwanese Association of Oral and Maxillofacial Surgeons

Specialist, Taiwan Academy of Craniomandibular Disorders

Specialist, Taiwan Academy of Implant Dentistry

Director, Board of Taiwan Academy of Craniomandibular Disorders

Director, Board of Taiwan Academy of Implant Dentistry

Member, International Team for Implantology