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Çelik ZM, Bayram F, Aktaç Ş, Berkel G, Güneş FE. Evaluation of pre- and postoperative nutrition and oral health-related quality of life in orthognathic surgery patients. Nutrition 2024; 123:112418. [PMID: 38569254 DOI: 10.1016/j.nut.2024.112418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Orthognathic surgery is a complex orofacial surgery that can significantly impact occlusal function and effect nutritional and quality of life parameters. This study aimed to evaluate alterations in dietary intake, chewing function, physical activity, and oral health-related quality of life of patients undergoing orthognathic surgery. RESEARCH METHODS AND PROCEDURES In this prospective longitudinal study, the assessments were conducted at: preoperatively (T0) and postoperative first week (T1), second week (T2), first month (T3), and third month (T4) between May 2021 and March 2023. Sociodemographic questionnaire, 24-h dietary recall record, chewing ability form, International Physical Activity Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) was applied at face-to-face interviews. RESULTS Seventy eligible orthognathic surgery patients were evaluated, and 37 patients (52.8%) completed this study. Energy and fat intake significantly decreased from T0 to T1 (P < 0.001) and returned to basis by T4 (P = 0.015). Fiber intake was found to be lowest at T1 and T2 compared with other time points (P < 0.001). Chewing ability showed a deterioration and then improvement; however, patients still had difficulties chewing hard foods at T4. The OHIP-14 increased at T2 and T3 from T0 (P < 0.001 and P = 0.021, respectively) and showed a significant improvement at T4 (P < 0.05). CONCLUSION The findings indicate a temporary decline in nutritional intake and chewing ability with subsequent recovery by the third month postsurgery. These changes, along with the trends in oral health-related quality of life, underscore the need for tailored nutritional and functional rehabilitation programs following orthognathic surgery.
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Affiliation(s)
- Zehra Margot Çelik
- Department of Nutrition and Dietetics, Marmara University, Faculty of Health Sciences, Istanbul, Türkiye.
| | - Ferit Bayram
- Department of Oral and Maxillofacial Surgery, Marmara University, Faculty of Dentistry, Istanbul, Türkiye
| | - Şule Aktaç
- Department of Nutrition and Dietetics, Marmara University, Faculty of Health Sciences, Istanbul, Türkiye
| | - Gülcan Berkel
- Department of Oral and Maxillofacial Surgery, Marmara University, Faculty of Dentistry, Istanbul, Türkiye
| | - Fatma Esra Güneş
- Department of Nutrition and Dietetics, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Türkiye
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Sadputranto SA, Setiawan AS, Maskoen AM, Laviana A, Sjamsudin E. Orthognathic Surgery as Class III Skeletal Treatment in a 31-Year-Old Female with Mandible Prognathism: A Case Report. Eur J Dent 2023; 17:935-942. [PMID: 36977475 PMCID: PMC10569864 DOI: 10.1055/s-0043-1761453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Mandible prognathism or malocclusion skeletal class III is facial deformities. These deformities can affect orofacial function, such as mastication, speech, and function of the temporomandibular joint. Besides the physical effects of these deformities, the psychosocial impact on the individual is often essential, and such deformities can affect the quality of life and self-confidence. Orthognathic surgery is designed to correct these deformities because these deformities could not have been corrected by only orthodontic treatment. Therefore, at Hasan Sadikin General Hospital, orthognathic surgery is the treatment choice for mandibular prognathism or malocclusion skeletal class III. In this case report, we present a 31-year-old female with mandibular prognathism, difficulty in closing her mouth and anterior open bite. Surgery was performed by Le Fort 1 osteotomy for advancing maxilla and bilateral sagittal split osteotomy for setback mandible. Two weeks after surgery, patient came back to the orthodontic department for occlusion treatment.
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Affiliation(s)
| | - Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Ani Melani Maskoen
- Department of Oral Biology Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Avi Laviana
- Department of Orthodontic Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Sjamsudin
- Department of Oral Maxillofacial Surgeon Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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Singh H, Mishra S, Srivastava D, Sharma P, Chandra L, Kapoor P, Maurya RK. Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up. Prague Med Rep 2023; 124:265-282. [PMID: 37736950 DOI: 10.14712/23362936.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.
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Affiliation(s)
- Harpreet Singh
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
| | - Sonal Mishra
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, New Delhi, India.
| | - Dhirendra Srivastava
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, New Delhi, India
| | - Poonam Sharma
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
| | - Lokesh Chandra
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, New Delhi, India
| | - Pranav Kapoor
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
| | - Raj Kumar Maurya
- Department of Orthodontics, Central Government Dental Unit, Dehradun, India
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dos Santos VDB, Queiroz SIML, da Silva AC, Silva S, da Silva JSP, Fernandes GVDO, Germano AR. Evaluation of the Anatomic Position of the Mandibular Canal Regarding to the Segments of the Mandibular Sagittal Split Ramus Osteotomy to Diminish the Possibility of Injuries: a Pilot Study. J Oral Maxillofac Res 2022; 13:e2. [PMID: 36788795 PMCID: PMC9902025 DOI: 10.5037/jomr.2022.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
Objectives This pilot study evaluated the relationship between inferior alveolar nerve location through computed tomography scan and intraoperative inferior alveolar nerve entrapment after bilateral sagittal split osteotomy. Material and Methods Overall, 20 helicoidal computed tomography scans were evaluated in patients with facial deformities who underwent to bilateral sagittal split osteotomy (BSSO). The distance from the mandibular canal to the internal surface of the buccal and lingual cortical bone, mandibular thickness, bone density and proportion of medullary and cortical bone in 3 regions were evaluated. During the intraoperative period, the segment to which the nerve remained adhered after performing BSSO was analysed, and the data correlated. Results The distance from the mandibular canal to the buccal cortical bone showed a mean of 2.6 mm when the inferior alveolar nerve was adhered to the distal segment and mean of 0.7 mm when the nerve was adhered to the proximal segment. The thickness was 11.2 mm and 9.8 mm when the nerve was adhered the distal the proximal segments respectively. Mandibular thickness, distance from the mandibular canal to the buccal and lingual cortical were statistically related to intraoperative nerve entrapment (P < 0.05). Conclusions Narrow jaws and the distance from the mandibular canal to buccal cortical bone less than 2 mm increases the risk of the inferior alveolar nerve entrapment in bilateral sagittal split osteotomy.
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Affiliation(s)
| | | | | | - Susana Silva
- Departamento de Ortodontia da Universidade Católica de Viseu, ViseuPortugal.
| | - José Sandro Pereira da Silva
- Oral Maxillofacial and Trauma Surgery of the “Hospital Universitário Onofre Lopes”, Federal University of Rio Grande do Norte, Natal, Rio Grande do NorteBrazil.
| | | | - Adriano Rocha Germano
- Oral Maxillofacial and Trauma Surgery of the “Hospital Universitário Onofre Lopes”, Federal University of Rio Grande do Norte, Natal, Rio Grande do NorteBrazil.
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Quah B, Sng TJH, Yong CW, Wen Wong RC. Orthognathic Surgery for Obstructive Sleep Apnea. Oral Maxillofac Surg Clin North Am 2022; 35:49-59. [DOI: 10.1016/j.coms.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leck R, Paul N, Rolland S, Birnie D. The consequences of living with a severe malocclusion: A review of the literature. J Orthod 2022; 49:228-239. [PMID: 34488471 PMCID: PMC9160782 DOI: 10.1177/14653125211042891] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
AIM To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion. METHODS A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme. RESULTS The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias. CONCLUSION This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.
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Affiliation(s)
- Richard Leck
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - Ninu Paul
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - Sarah Rolland
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - David Birnie
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
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Halepas S, Bryck B, Lee KC, Koch A. The Liability of Performing Orthognathic Surgery. Craniomaxillofac Trauma Reconstr 2022; 15:128-131. [DOI: 10.1177/19433875211022530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design: This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription-based database of over 40,000 state and federal records. Objective: There is growing academic interest in the medical malpractice literature. The primary objective of this study was to examine medical malpractice in orthognathic procedures in order to characterize factors that determine legal responsibility and help make the craniomaxillofacial (CMF) surgeon more comfortable when treating this patient population. Methods: The database was queried for medical malpractice cases involving orthognathic surgery from 1985-2021. The characteristics of each lawsuit were identified, and descriptive statistics were reported. Results: A total of 42 CMF malpractice cases were available for review, and total of 15 cases were included in the final sample. Verdict decisions and settlements occurred between 1991 and 2012. Of the 15 cases, the highest concentration of cases occurred in California (6) and Pennsylvania (2). 53% of cases were ruled in favor of the defendant, 7% of cases were settled, 27% of cases were ruled in favor of the plaintiff against the surgeon, and 13% were ruled in favor of the plaintiff against the hospital with the surgeon being found not liable. The minimum award of damages was $29,999 and the maximum was $550,000. Conclusion: Litigation experience can be very time consuming and troublesome for medical practitioners. The risk of litigation and complications might be a prohibiting factor as to why CMF surgeons may not be preforming orthognathic surgery. The best defense against a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal.
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Affiliation(s)
- Steven Halepas
- Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Brendan Bryck
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - Kevin C. Lee
- Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Alia Koch
- Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery-a 10-year retrospective study. Oral Maxillofac Surg 2022:10.1007/s10006-022-01073-y. [PMID: 35595944 DOI: 10.1007/s10006-022-01073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications. METHODS The electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed. RESULTS Two hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group. CONCLUSION The HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior-posterior transpositions of the mandible.
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Damrongsirirat N, Kaboosaya B, Siriwatana K, Subbalekha K, Jansisyanont P, Pimkhaokham A. Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center. J Craniomaxillofac Surg 2021; 50:197-203. [PMID: 34876326 DOI: 10.1016/j.jcms.2021.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022] Open
Abstract
This article aimed to review adverse events and complications to orthognathic surgery based upon 10 years. This study was a retrospective investigation between 2009 and 2018. Independent variables such as sex, age, pre-operative conditions, diagnosis, type of surgery, bleeding volume, surgery duration, and hospitalization were recorded. The data regarding orthognathic surgery adverse events and complications were evaluated and statistically analyzed with a significance level of p < 0.05. A total of 891 patients were included in this study (male 39.1%, female 60.9%) with a mean age of 26.4 ± 6.09 years. A neurosensory disturbance was found as immediate post-operative sequelae as 93.5%. The four most frequent complications had a relapse (6.4%), post-operative TMD (5.7%), unfavorable osteotomy (5.5%), and infection (4.9%), which seem to be more common in males. An average blood loss was 497 ± 371 ml and the average operative time was 401 ± 109.3 min. Complication rates were statistically affected by bleeding volume (p-value = 0.01), operative time (p-value = 0.03), and type of skeletal deformity (p-value = 0.01). Although numerous complications were recorded, no fatal complications were experienced. Bleeding time, operative time, and skeletal classification have significant influence on orthognathic surgery complications. However, a multitude of factors could be modified to reduce the complication rate and improve the result of the treatment. One of the most significant factors was the operative time.
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Affiliation(s)
- Napat Damrongsirirat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
| | - Kiti Siriwatana
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Pornchai Jansisyanont
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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10
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Higher need for removal of osteosynthesis material after multi-piece versus one-piece Le Fort I osteotomy: A retrospective study of 339 patients. J Craniomaxillofac Surg 2021; 50:204-210. [DOI: 10.1016/j.jcms.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/07/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
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The Assessment of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy With Subjective and Three-Dimensional Evaluation. J Craniofac Surg 2021; 33:1136-1142. [PMID: 34611107 DOI: 10.1097/scs.0000000000008261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Inferior alveolar neurosensory disturbance (IAND) is the most common complication of bilateral sagittal split osteotomy (BSSO). The aim of the present study was to evaluate IAND with subjective tests postoperatively and assess the relationship between three-dimensional measurements of the mandibular canal (MC) and IAND. METHODS Eighteen patients (Mean age: 24.05 ± 5.85 years) treated with BSSO were retrieved from the archive. Subjective tests (light touch, tactile sensitivity, 2-point discrimination, brush-stroke directional discrimination, sharp/blunt discrimination, dental vitality, questionnaire) and three-dimensional measurements related to MC and fixation screws were done postoperatively (on average 20.43 ± 8.76 months after surgery). Statistical significance was set at P < 0.05. RESULTS Subjective test results were found compatible with each other except brush-stroke directional discrimination test. According to the questionnaire, IAND was apparent in all patients immediately after surgery, and recovery after 1 to 2 years was statistically significant (P < 0.05). Preoperative ramus width, medial and lateral cancellous bone lengths, the decrease in MC length, and the presence of screw in MC were not related to IAND (P < 0.05). CONCLUSIONS There is a high incidence of IAND following BSSO, and the subjective tests are efficient to evaluate the disturbance. Spontaneous recovery of the nerve occurs during the follow-up periods. Instead of preoperative measurements of bone thickness, MC length, and the position of fixation screws, the surgical procedure seems to be more important in IAND occurrence.
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Bahmanyar S, Namin AW, Weiss RO, Vincent AG, Read-Fuller AM, Reddy LV. Orthognathic Surgery of the Mandible. Facial Plast Surg 2021; 37:716-721. [PMID: 34587642 DOI: 10.1055/s-0041-1735309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.
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Affiliation(s)
- Sara Bahmanyar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Arya W Namin
- Department of Otolaryngology, University of Missouri School of Medicine, University of Missouri, Columbia, Missouri
| | - Robert O Weiss
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
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Abstract
ABSTRACT In the surgical procedures such as osteotomy to be applied to ramus of the mandible, care should be taken not to damage the inferior alveolar nerve (IAN). The safe zone, which is the area above and behind the mandibular foramen (MF), is the ramus of mandible area, where these surgeries can be performed without damaging the inferior alveolar neurovascular bundle. It was aimed to determine the safe zone in the ramus of mandible in the cone-beam computed tomography (CBCT) images of individuals. The CBCT images of 300 Turkish individuals between the ages of 18 to 65 were bilaterally and retrospectively evaluated. Three parameters on the sagittal and two parameters on the axial plane were measured. Additionally, two ratios were calculated which determined the superior and posterior part of the safe zone through the measured parameters. In this study, the safe zone was determined as the area where 55% of the upper part and 49% of the posterior part of the mandibular ramus. Determining the safe zone in surgical procedures to be applied to the ramus of mandible will help protect the neurovascular structures passing through the MF, reduce complications and increase the success rate of the surgical procedure. However, it is seen that there are few studies on this subject in the literature and there are some differences between these studies. The authors think that preoperative CBCT screening will be safer for each patient in the mandibular ramus osteotomies and more studies should be done on different populations to determine standard values.
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Din AR, Buckley N, Ali N, Millwaters M, Sharma PK. A prospective cohort study evaluating subjective and objective neurosensory changes following LeFort I osteotomy. Am J Orthod Dentofacial Orthop 2021; 160:410-422. [PMID: 33975747 DOI: 10.1016/j.ajodo.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to investigate the incidence and recovery of neurosensory deficit (NSD) after LeFort I osteotomy over 12 months and identify any association between age, gender, and extent of surgical movement on recovery. Furthermore, the study explored the relationship between objective and subjective outcome measures. METHODS A prospective cohort study consisting of 31 patients. Subjects were assessed at baseline, 1 week (T1), 1 month, 3 months, 6 months, and 12 months (T5) after LeFort I osteotomy. Objective assessment measures included pinprick (PP), static light touch (SLT), static 2-point discrimination (STPD), and electric pulp testing (EPT). Subjective reporting was undertaken using a visual analog scale. Patients rated the impact of NSD on intraoral and extraoral sites at the same time points as for objective measures. RESULTS Twenty-eight patients (16 females and 12 males) with a mean age of 24.5 years (standard deviation, 7.4) completed the study. There was a notable reduction in NSD from T1 (85.7%) to T5 (17.9%). No significant differences were found with respect to the influence of gender; PP (P = 0.06), SLT (P = 0.10), STPD (P = 0.65) and EPT (P = 0.19) or extent of surgical movement; PP (P = 0.50), SLT (P = 0.72), STPD (P = 0.06) and EPT (P = 0.74) on NSD. Age is a significant factor for intraoral NSD in the immediate postoperative period; PP (P < 0.0001) and SLT (P < 0.0001). Subjectively, patients reported a high degree of concern associated with NSD immediately after surgery with a gradual reduction from T1 to T5. There is a significant difference in subjective reporting between those with intraoral NSD than those with no intraoral NSD at 12 months (P = 0.031). CONCLUSIONS NSD is high after LeFort I surgery, particularly intraorally in the palate. At 12 months, the incidence of NSD is 17.9%. Recovery of NSD to a nonsignificant value from baseline takes up to 3 months for extraoral sites and between 3 and 6 months for intraoral soft tissues. The maxillary dentition continues to recover from NSD up to 12 months postsurgery. Age, gender, and extent of the surgical movement do not influence the extent of NSD at 12 months. Increasing age is associated with increased NSD at intraoral sites immediately after surgery. Intraoral NSD is more of a concern to patients than extraoral NSD. Patients' concerns associated with NSD reduced over time, demonstrating a degree of adaptation in the longer term.
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Affiliation(s)
- Ahmed R Din
- Department of Orthodontics, The Royal London Hospital, London, United Kingdom
| | - Niamh Buckley
- Department of Orthodontics, The Royal London Hospital, London, United Kingdom
| | - Nayeem Ali
- Department of Oral and Maxillofacial Surgery, The Royal London Hospital, London, United Kingdom
| | - Michael Millwaters
- Department of Oral and Maxillofacial Surgery, The Royal London Hospital, London, United Kingdom
| | - Pratik K Sharma
- Centre for Oral Bioengineering, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
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Peleg O, Mahmoud R, Shuster A, Arbel S, Manor Y, Ianculovici C, Kleinman S. Orthognathic surgery complications: The 10-year experience of a single center. J Craniomaxillofac Surg 2021; 49:891-897. [PMID: 33994296 DOI: 10.1016/j.jcms.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022] Open
Abstract
The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reema Mahmoud
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shimrit Arbel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yifat Manor
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Herrera-Vizcaino C, Seifert L, Berdan M, Ghanaati S, Klos M, Landes C, Sader R. Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article). Clin Oral Investig 2020; 25:3229-3236. [PMID: 33106901 PMCID: PMC8060227 DOI: 10.1007/s00784-020-03653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. PATIENT AND METHODS The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. RESULTS A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009-211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). CONCLUSION The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. CLINICAL RELEVANCE The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.
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Affiliation(s)
- C Herrera-Vizcaino
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - L Seifert
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - M Berdan
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - S Ghanaati
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - M Klos
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - C Landes
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Sana Klinikum, Offenbach am Main, Germany
| | - Robert Sader
- Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany.
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Carlos HV, Marta BL, Orlando PM, Samuel UE, Sader R, Seifert LB. Stress distribution is susceptible to the angle of the osteotomy in the high oblique sagittal osteotomy (HOSO): biomechanical evaluation using finite element analyses. Comput Methods Biomech Biomed Engin 2020; 24:67-75. [PMID: 32845167 DOI: 10.1080/10255842.2020.1810242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM This computational study aimed to evaluate the influence of the angle of the osteotomy when performing a high oblique sagittal osteotomy over the distribution of stress to the osteosynthesis plates and mandibular segments. Material and methods: For this purpose, a finite element analysis of different combinations was carried out based on the osteotomy angle and mandibular mobilization using Autodesk Inventor® resulting in a total of 72 simulations. To check the correlation between the osteotomy angles with respect to the tension in the mandibular structure in different mobilizations, a student t-test was used. Results: The results of the advancement mobilizations (2.5 mm to 5.5 mm) reported increasing values for tension in the probe of the fourth screw and in the probe of the plate surface as the osteotomy angle increased (p-value <10-8). The results of the setback mobilizations (-2.5 mm to -5.5 mm) show comparable values (p-value <10-8). The resulting contact surface between bone segments varies depending on the osteotomy angle, increasing 44.67% from 45° to 70° and decreasing 22.05% when the angle is reduced to 30°. Conclusion: The angle of the osteotomy is a very relevant parameter in the design of the studied mandibular osteotomy, since the distribution of the reported stresses is substantially susceptible to its variation.
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Affiliation(s)
- Herrera-Vizcaíno Carlos
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Baselga Lahoz Marta
- Applied Mechanics and Bioengineering Group (AMB) of Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | | | - Udeabor E Samuel
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Robert Sader
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lukas Benedikt Seifert
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Mota de Paulo JP, Herbert de Oliveira Mendes F, Gonçalves Filho RT, Marçal FF. Combined Orthodontic-Orthognathic Approach for Dentofacial Deformities as a Risk Factor for Gingival Recession: A Systematic Review. J Oral Maxillofac Surg 2020; 78:1682-1691. [PMID: 32615098 DOI: 10.1016/j.joms.2020.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/02/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The objective of this systematic review was to evaluate the risk of development of gingival recession (GR) as a result of the combined orthodontic-orthognathic approach. MATERIALS AND METHODS The PubMed, Google Scholar, ClinicalTrials.gov, and Cochrane Library databases were searched. Included articles mentioned gingival parameters in their materials and methods sections; specifically, they evaluated GR, which was measured before and after the surgical procedure. Study parameters such as methodology, evaluation period, sample characteristics, and follow-up were extracted by 2 authors independently. RESULTS In total, 133 relevant articles were identified from the databases; after screening and full-text analysis, 9 studies were included in this systematic review. Meta-analysis could not be conducted because of considerable heterogeneity in methods. The incidence of GR in the range of 0.5 to 3.0 mm as a significant clinical finding after orthognathic surgery showed statistically significant differences in all included articles. Among patients with GR, the mean age was 23.0 to 29.5 years and the mandibular incisors were the most common site. However, no case of recession greater than 3.0 mm was associated with surgery. CONCLUSIONS On the basis of the findings of this review, GR of approximately 0.5 to 3.0 mm is a common finding after the combined orthodontic-orthognathic approach. Although periodontal damage up to 3 mm can be observed as an isolated finding in mainly the incisors, true recession is not associated with orthognathic surgery in general.
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Affiliation(s)
- João Paulo Mota de Paulo
- Graduation Student in Dentistry, Department of Clinical Dentistry, Christus University Center, Fortaleza, Brazil
| | | | | | - Felipe Franco Marçal
- Professor, Department of Clinical Dentistry, Christus University Center, Fortaleza, Brazil.
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Treatment of an Adult Skeletal Class III Patient with Surgically Assisted Rapid Palatal Expansion and Facemask. Case Rep Dent 2019; 2019:8251903. [PMID: 31976090 PMCID: PMC6955136 DOI: 10.1155/2019/8251903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/21/2019] [Indexed: 11/23/2022] Open
Abstract
This case report presents the treatment of a 21-year-old male patient with class III skeletal malocclusion, an open bite, and vertical growth pattern. He was managed with surgically assisted rapid palatal expansion (SARPE) along with an orthopedic facemask. The duration of treatment was 16 months. Significant improvement and favourable outcome were observed concerning both facial appearance and paraclinical parameters after completion of treatment.
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Zaroni FM, Cavalcante RC, João da Costa D, Kluppel LE, Scariot R, Rebellato NLB. Complications associated with orthognathic surgery: A retrospective study of 485 cases. J Craniomaxillofac Surg 2019; 47:1855-1860. [PMID: 31813754 DOI: 10.1016/j.jcms.2019.11.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors. METHODS This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05. RESULTS A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05). CONCLUSION Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.
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Affiliation(s)
- Fabio Marzullo Zaroni
- Department of Stomatology, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400, Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Rafael Correia Cavalcante
- Department of Stomatology, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400, Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Delson João da Costa
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Leandro Eduardo Kluppel
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Rafaela Scariot
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil; School of Health Science, Oral and Maxillofacial Surgery Department, Positivo University, 5300 Professor Pedro Viriato Parigot de Souza Street, Campo Comprido, 81280-330, Curitiba, Paraná, Brazil.
| | - Nelson Luis Barbosa Rebellato
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
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Ketoff S, Sigaux N, Raberin M, Bouletreau P. [Dental complications during orthodontic preparation and orthognathic surgery]. Orthod Fr 2018; 89:137-144. [PMID: 30040613 DOI: 10.1051/orthodfr/2018010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/12/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Orthodontic-surgical treatment can present risks to the dental organ and the periodontium. Despite the low incidence of such cases, these complications can compromise a treatment plan. Practitioners should be aware of these potential complications, take them into account during treatment in order to reduce their negative impact and, if necessary, manage them by orthodontic-surgical collaboration. MATERIALS AND METHODS In this article, the authors present several potential complications that can occur during treatment. CONCLUSION The information given to the patient about the risks inherent in the implementation of an orthodontic-surgical protocol must necessarily include the risks of lesion to the dental organ and the periodontium.
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Affiliation(s)
- Serge Ketoff
- Service de Chirurgie maxillo-faciale, Hôpital Paris Saint-Joseph, 185 rue Raymond-Losserand, 75014 Paris, France
| | - Nicolas Sigaux
- Service de Chirurgie maxillo-faciale, Centre hospitalier Lyon-Sud, 165 chemin du Grand-Revoyet, 69495 Pierre Bénite cedex, France
| | | | - Pierre Bouletreau
- Service de Chirurgie maxillo-faciale, Centre hospitalier Lyon-Sud, 165 chemin du Grand-Revoyet, 69495 Pierre Bénite cedex, France
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Assis GLCD, Sousa CS, Turrini RNT, Poveda VDB, Silva RDCGE. Proposal of nursing diagnoses, outcomes and interventions for postoperative patients of orthognathic surgery. Rev Esc Enferm USP 2018; 52:e03321. [PMID: 29947703 DOI: 10.1590/s1980-220x2017025303321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/14/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To propose nursing diagnoses, outcomes and interventions for patients in the postoperative period of orthognathic surgery. METHOD Secondary analysis of an information bank of a focal group with five patients submitted to orthognathic surgery. The classifications of the North American Nursing Diagnosis Association International, Nursing Outcomes Classification and Nursing Interventions Classification were used for elaborating nursing diagnoses, outcomes and interventions. Nursing diagnoses were identified based on the transcription of the focus group and the expected outcomes and interventions were proposed. In the second stage, the material was submitted to an analysis by judges for validating the previous stage. RESULTS After careful analysis of the retrieved information, nine nursing diagnoses that relate to both the difficulties already installed and to potential patient difficulties were identified. After this phase, the expected outcomes for nursing care and the appropriate interventions for the postoperative period at home were identified. CONCLUSION Given the short hospital stay and the long postoperative period, the established actions have a strong educational focus.
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Sahin T, Garreau E, Komakli Y, Nicot R, Sciote J, Ferri J. Mandibular anterior segmental subapical osteotomy for incisor axis correction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017. [DOI: 10.1016/j.jormas.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Singh V, Sudhakar KNV, Mohanty R, Chatterjee S. Orthognathic Surgery: A Review of Articles Published in 2014-2015. J Maxillofac Oral Surg 2017; 16:284-291. [PMID: 28717285 PMCID: PMC5493559 DOI: 10.1007/s12663-016-0990-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published. METHOD A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea. RESULTS Bulk of the studies were retrospective, and less interest was shown onto experimental researches. CONCLUSION A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.
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Affiliation(s)
- Vaibhav Singh
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Kiit University, Bhubaneswar, 751024 India
| | - K. N. V. Sudhakar
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Kiit University, Bhubaneswar, 751024 India
| | - Rajat Mohanty
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Bhubaneswar, India
| | - Suravi Chatterjee
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Bhubaneswar, India
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Friscia M, Sbordone C, Petrocelli M, Vaira LA, Attanasi F, Cassandro FM, Paternoster M, Iaconetta G, Califano L. Complications after orthognathic surgery: our experience on 423 cases. Oral Maxillofac Surg 2017; 21:171-177. [PMID: 28251364 DOI: 10.1007/s10006-017-0614-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. MATERIALS AND METHODS Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. RESULTS One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). CONCLUSIONS Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.
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Affiliation(s)
- Marco Friscia
- Department of Maxillo-Facial Surgery, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy
| | - Carolina Sbordone
- Department of Maxillo-Facial Surgery, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy
| | - Marzia Petrocelli
- Department of Maxillo-Facial Surgery, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy
| | - Luigi Angelo Vaira
- Department of Maxillo-Facial Surgery, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy.
| | - Federica Attanasi
- Statistical Science Department, School of Statistic Science, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Francesco Maria Cassandro
- Dentistry Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 9, 80100, Naples, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, Legal Medicine Unit, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy
| | - Giorgio Iaconetta
- Department of Neurosurgery, School of Medicine, University of Salerno, Via S. Allende, 84081, Baronissi, Salerno, Italy
| | - Luigi Califano
- Department of Maxillo-Facial Surgery, School of Medicine, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy
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Hegarty E, Campbell C, Grammatopoulos E, DiBiase AT, Sherriff M, Cobourne MT. YouTube™ as an information resource for orthognathic surgery. J Orthod 2017; 44:90-96. [DOI: 10.1080/14653125.2017.1319010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Emmett Hegarty
- Department of Orthodontics, King’s College London Dental Institute, London, UK
- Department of Orthodontics, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, UK
| | - Ciara Campbell
- Department of Orthodontics, Altnagelvin Hospital Western HSC Trust, UK
| | - Ektor Grammatopoulos
- Department of Orthodontics, King’s College London Dental Institute, London, UK
- Department of Orthodontics, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, UK
| | - Andrew T. DiBiase
- Department of Orthodontics, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, UK
| | - Martyn Sherriff
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Martyn T. Cobourne
- Department of Orthodontics, King’s College London Dental Institute, London, UK
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27
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Alveolar nerve impairment following bilateral sagittal split ramus osteotomy and genioplasty. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gao X, Wang T, Song J. Orthodontic and surgical management of a patient with severe skeletal Class II deformity and facial asymmetry: A case report with a 5-year follow-up. Am J Orthod Dentofacial Orthop 2017; 151:779-792. [PMID: 28364902 DOI: 10.1016/j.ajodo.2016.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 10/19/2022]
Abstract
In this case report, we present the orthodontic and surgical management of an 18-year-old girl who had a severe craniofacial deformity, including maxillary prognathism, vertical maxillary excess (gummy smile), mandibular retrognathism, receding chin, and facial asymmetry caused by unilateral temporomandibular joint ankylosis. For correction of the facial asymmetry, the patient's right mandibular ramus and body were lengthened via distraction osteogenesis after 5 months of preoperative orthodontic therapy. Subsequently, extraction of 4 first premolars, bimaxillary anterior segmental osteotomy, and genioplasty were simultaneously performed in the second-stage operation to correct the skeletal deformities in the sagittal and vertical planes. Postoperative orthodontic treatment completed the final occlusal adjustment. The total active treatment period lasted approximately 30 months. The clinical results show that the patient's facial esthetics were significantly improved with minimal surgical invasion and distress, and a desirable occlusion was achieved. These pleasing results were maintained during the 5-year follow-up.
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Affiliation(s)
- Xiang Gao
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Wang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jinlin Song
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China.
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Early Complications From the Use of Calcium Phosphate Paste in Mandibular Lengthening Surgery. A Retrospective Study. J Oral Maxillofac Surg 2017; 75:1274.e1-1274.e10. [PMID: 28219630 DOI: 10.1016/j.joms.2017.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Calcium phosphate paste is used in mandibular lengthening surgery to avoid unesthetic notching at the lower border and to help stabilize the segments when osteosynthesis slippage is a concern. The aim of this study was to investigate whether the hardened paste increases the incidence of infections. MATERIALS AND METHODS This was a retrospective cohort study of medical charts of all patients who underwent a bilateral sagittal split osteotomy from February 2012 through July 2015. The outcome and predictor variables were postoperative infection and calcium phosphate paste use, respectively. Other study variables included age, gender, tobacco use, type of fixation, type of surgery, antibiotic prophylaxis regimen, third molar extraction, and medical comorbidities. Variables were analyzed using the Fisher exact test and logistic regression. RESULTS The sample included 196 patients (115 female and 81 male) 9 to 57 years old. The overall infection rate was 12.2%. Of the 102 patients who received calcium phosphate paste, 18.6% developed an infection compared with 5.3% in the control group. The difference in infection rate was statistically significant (odds ratio = 0.14; 95% confidence interval [CI], 0.04-0.48; P = .002) after adjusting for the other variables. Of the 392 surgical sites, 204 had received calcium phosphate paste, of which 10.3% became infected. Of the 188 sites without defect reconstruction, 6 (3.2%) became infected (P = .008 by bivariate analysis). There was a statistically significant association between third molar removal and infections (odds ratio = 8.01; 95% CI, 1.28-50.1; P = .026) and between the use of amoxicillin plus clavulanate and the use of cefazolin (odds ratio = 3.92; 95% CI, 0.87-17.63; P = .07). CONCLUSION There was a relevant trend of increased infection with calcium phosphate paste use. Third molar removal also was identified as a risk factor. Prospective studies after procedural modifications are recommended to determine whether the benefits of using calcium phosphate paste outweigh the risks.
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Evaluation of oral health related quality of life in patients undergoing orthognathic surgery. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Posnick JC, Choi E, Chavda A. Surgical Site Infections Following Bimaxillary Orthognathic, Osseous Genioplasty, and Intranasal Surgery: A Retrospective Cohort Study. J Oral Maxillofac Surg 2016; 75:584-595. [PMID: 27746257 DOI: 10.1016/j.joms.2016.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Frequency estimates of surgical site infection (SSI) after orthognathic surgery vary considerably. The purpose of this study was to determine the incidence and site of SSIs and associated risk factors after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. MATERIALS AND METHODS The authors executed a retrospective cohort study of patients with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. All patients underwent at a minimum Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was the incidence and site of SSI. Predictor variables were type and extent of prophylactic antibiotic used, demographic (age and gender), and anatomic (pattern of DFD, surgical site, and presence of third molar). RESULTS Two hundred sixty-two patients met the inclusion criteria. Their average age at surgery was 25 years (range, 13 to 63 yr) and there were 134 female patients (51%). The major presenting patterns of DFD included long face (30%) and maxillary deficiency (25%). Forty percent of patients undergoing an SRO and 47% of those undergoing a Le Fort I osteotomy underwent simultaneous removal of a third molar. Ninety percent of patients received cefazolin or cephalexin antibiotics. Overall, 5 of 1,048 (0.5%) osteotomy sites sustained an infection, including 1 chin and 4 ramus SSIs. There were no delays in bone healing. Fixation hardware removal was not required in any patient who developed an infection. Two of the 25 patients (8%) given clindamycin prophylaxis developed an SSI, whereas 3 of 237 patients (1%) receiving cefazolin did. Three of the 4 patients who developed an SRO SSI underwent simultaneous removal of an erupted or partially erupted mandibular third molar (P < .05). CONCLUSIONS In this study, the incidence of SSI was limited to 1% of patients who were given cefazolin or cephalexin extended for 5 days. The removal of an erupted or partially erupted mandibular third molar in conjunction with an SRO was associated with risk of SSI, but the incidence remains low.
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Affiliation(s)
- Jeffrey C Posnick
- Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Department of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC.
| | - Elbert Choi
- California Oral Surgery and Implantology, Stockton, CA; Stanislaus Oral Surgery and Implantology, Modesto, CA; Former Chief Resident, Howard University Hospital, Washington, DC
| | - Anish Chavda
- Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC
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Posnick JC, Adachie A, Choi E. Segmental Maxillary Osteotomies in Conjunction With Bimaxillary Orthognathic Surgery: Indications – Safety – Outcome. J Oral Maxillofac Surg 2016; 74:1422-40. [DOI: 10.1016/j.joms.2016.01.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
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Abstract
Orthognathic surgery including maxillary osteotomy, mandibular osteotomy, and genioplasty is a reliable treatment strategy for jaw deformity. However, there are some complications associated with these surgeries, including neurovascular damage and abnormal bleeding. The authors present here a patient of aspiration pneumonia after mandibular osteotomy.An 18-year-old female patient underwent sagittal split ramus osteotomy and genioplasty for mandibular prognathism. She began choking and coughing immediately after surgery. She was diagnosed with aspiration pneumonia based on chest radiography and computed tomography findings. Her hyoid bone was shifted 23 mm inferiorly after surgery, and this movement may have caused swallowing dysfunction. She was treated with intravenous antibiotics and discharged on the 18th postoperative day.Although the hyoid bone is transiently shifted inferiorly by mandibular setback with or without genioplasty, this shift does not usually affect swallowing function. Damage to the suprahyoid muscles during genioplasty may cause both an inferior shift and dysmobility of the hyoid bone. Therefore, surgeons must be careful not to damage the suprahyoid muscles at the lingual site osteotomy in genioplasty to avoid this complication.
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Christabel A, Anantanarayanan P, Subash P, Soh C, Ramanathan M, Muthusekhar M, Narayanan V. Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: a prospective, multi-centre, triple-blind, randomized controlled trial. Int J Oral Maxillofac Surg 2016; 45:180-5. [DOI: 10.1016/j.ijom.2015.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/10/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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Cunningham SJ, Johal A. Orthognathic correction of dento-facial discrepancies. Br Dent J 2015; 218:167-75. [DOI: 10.1038/sj.bdj.2015.49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
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Sousa CS, Turrini RNT. Creating and Validating Educational Material for Patients Undergoing Orthognathic Surgery. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:166-72. [DOI: 10.1016/j.anr.2012.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 10/11/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022] Open
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Santos MRMD, Sousa CS, Turrini RNT. Percepção dos pacientes submetidos à cirurgia ortognática sobre o cuidado pós-operatório. Rev Esc Enferm USP 2012; 46 Spec No:78-85. [DOI: 10.1590/s0080-62342012000700012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/18/2012] [Indexed: 11/22/2022] Open
Abstract
A ansiedade e a preocupação dos pacientes decorrentes da obscuridade das informações relacionadas ao procedimento cirúrgico ortognático despertou o desenvolvimento deste estudo, que objetivou identificar as necessidades de informação do paciente sobre o cuidado pós-operatório da cirurgia ortognática. Trata-se de pesquisa exploratória qualitativa, que utilizou como método de coleta de dados o grupo focal com pacientes em pós-operatório de cirurgia ortognática de um ambulatório de cirurgia e traumatologia bucomaxilofacial. Os dados foram submetidos à análise de conteúdo para identificação das falas significativas para o alcance do objetivo. Entre os assuntos mais abordados, destacaram-se o longo tempo de recuperação e as dificuldades relacionadas à alimentação, higienização e redução dos sinais e sintomas pós-operatórios. Comentários relacionados à autoimagem e à satisfação com os resultados da cirurgia apontam para a necessidade de exploração em futuros estudos.
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Sousa CS, Turrini RNT. Validação de constructo de tecnologia educativa para pacientes mediante aplicação da técnica Delphi. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000600026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever o processo de validação de uma tecnologia educativa para pacientes submetidos à cirurgia ortognática, mediante a aplicação da técnica Delphi. MÉTODOS: Participaram do estudo, dez juízes (quatro cirurgiões bucomaxilofaciais, duas enfermeiras, duas nutricionistas e duas fonoaudiólogas) que indicaram os assuntos a serem abordados no material destinado à primeira fase da técnica Delphi. Após a construção do material e a obtenção dos resultados da primeira fase, iniciou-se as segunda e terceira fases dessa técnica com validação da pertinência das informações contidas nessa tecnologia educativa. RESULTADOS: Na segunda rodada, obteve-se, pelo menos, 90,0% de concordância em todas as categorias. Na terceira, houve um aumento de 12% para o item conteúdo, melhora de 6,7% em linguagem, de 12,5% em ilustrações, de 3,3% no layout, de 10% em cultura, mantendo-se constante o item motivação. CONCLUSÃO: A técnica Delphi, pode ser uma importante ferramenta na construção e validação de tecnologias educativas.
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