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Aliabadi E, Eskandari F, Zanjani M, Babouei M. Post-BSSO condylar position stability: a comparison of miniplate and lag screw fixation. BMC Oral Health 2024; 24:728. [PMID: 38918762 PMCID: PMC11197225 DOI: 10.1186/s12903-024-04499-w] [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: 01/12/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND This study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split osteotomy (BSSO). METHODS This retrospective study included a cohort of 20 patients undergoing BSSO using the Obwegeser-Dal Pont modification. The bony segments were stabilized using either miniplates with two 2.0-mm monocortical screws per segment or three 2.0-mm bicortical lag screws along the mandible's superior border. Pre- and postoperative (7-day interval) spiral computed tomography scans were conducted to assess skeletal changes across both groups. Data analysis employed Wilcoxon signed-rank and Wilcoxon rank-sum tests (α = 0.05). RESULTS No statistically significant difference was observed between the pre-and postoperative condylar position parameters (P>0.05). However, the lag screw group showed a marginal significant increase in the left condyle's angulation (preoperative: 24.83 ± 6.37 vs. postoperative: 32.5 ± 4.93; P = 0.04). Changes in condylar height, length, and width were not statistically significant before and after BSSO in either groups (P>0.05). Nor was any statistically significant difference found between the miniplates and lag screws groups regarding condylar position parameters (P>0.05). CONCLUSION The results indicated that both lag screw and miniplate fixation methods can be effectively employed in BSSO procedures without impacting condylar position parameters. Thus, either fixation method can be chosen depending on factors such as the surgeon's preference and clinical outcomes.
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Affiliation(s)
- Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 71956-15878, Iran
| | - Fateme Eskandari
- School of Dentistry, Shiraz University of Medical Sciences, Ghasrdasht Street, Shiraz, 71956-15878, Iran
| | - Milad Zanjani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 71956-15878, Iran.
| | - Moslem Babouei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 71956-15878, Iran
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Leal JVB, Del Santo LM, Mahboob ONMNK, Ramos TMM, Cavalcante MB, Pessoa Neto JV. Mandibular reconstruction with TMJ prosthesis: management of osteomyelitis after orthognathic surgery (Case Report). Oral Maxillofac Surg 2024; 28:957-962. [PMID: 37847424 DOI: 10.1007/s10006-023-01184-0] [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: 04/24/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis.
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Affiliation(s)
- Joao Victor Borges Leal
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil.
| | - Luciano Mauro Del Santo
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | | | - Thiago Martins Magalhães Ramos
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | - Mateus Barros Cavalcante
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | - José Valdir Pessoa Neto
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
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Chen PRF, Chuang KT, Hsu SSP, Chen YR, Chen CT. Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1142e-1151e. [PMID: 37257138 DOI: 10.1097/prs.0000000000010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry. METHODS This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups. RESULTS Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients ( P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients ( P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment. CONCLUSION The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Kai-Ti Chuang
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital
| | | | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chien-Tzung Chen
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital at Linkou
- Craniofacial Research Center at Taoyuan, Chang Gung University, College of Medicine
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4
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Krisko AJ, Van Sickels JE. Delayed Presentation of Actinomycosis Following Orthognathic Surgery: An Old Nemesis and a Difficult Diagnosis: Case Presentation and Review of the Literature. Craniomaxillofac Trauma Reconstr 2024; 17:18-23. [PMID: 38371221 PMCID: PMC10874200 DOI: 10.1177/19433875231155986] [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: 02/20/2024] Open
Abstract
Study Design Review of the literature with report of Case. Objective To review the presentation of Actinomycosis specifically as it occurs with mandibular osteotomies. Methods A review of the literature and report of an additional case. Results While minor infections secondary to local factors are usually seen 2-3 weeks after surgery, late infections are rare. Host factors may play a role. When actinomycosis is diagnosed, long-term antibiotics are necessary. Conclusions Actinomycosis is very rare following orthognathic surgery. It usually occurs in the mandible and following a sagittal split. Time of presentation for actinomycosis can vary from 6 weeks to 4 months as in our case. Infections occurring this late after surgery should be treated with suspicion of actinomycosis obtaining both cultures and tissue biopsies. Treatment involves an incision and drainage and long-term antibiotics.
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Affiliation(s)
- Alexander J. Krisko
- Chief Resident Oral and Maxillofacial Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph E. Van Sickels
- Chief Resident Oral and Maxillofacial Surgery, University of Kentucky, Lexington, KY, USA
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Hattori Y, Huang PC, Chang CS, Chen YR, Lo LJ. Facial Palsy after Orthognathic Surgery: Incidence, Causative Mechanism, Management, and Outcome. Plast Reconstr Surg 2024; 153:697-705. [PMID: 37104501 DOI: 10.1097/prs.0000000000010597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be underreported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome. METHODS A retrospective review of orthognathic surgery records between January of 1981 and May of 2022 was conducted in the authors' craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiologic images, and photographs were collected. RESULTS A total of 20,953 sagittal split ramus osteotomies (SSROs) were performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, the Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than the Hunsuck technique using the manual twist splitting ( P < 0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median duration of 3 months [interquartile range (IQR), 2.75 to 6 months] after surgery, whereas 11.1% attained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster median recovery (3 months; IQR, 2 to 3 months) than the complete palsy patients (6 months; IQR, 4 to 6.25 months) ( P = 0.02). CONCLUSIONS The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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Affiliation(s)
- Yoshitsugu Hattori
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Po-Cheng Huang
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
| | - Chun-Shin Chang
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Yu-Ray Chen
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
| | - Lun-Jou Lo
- From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
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Lightfoot E, Jensen ED, Gamage SN, Cheng AH, Sambrook PJ. A Rare Complication of Maxillomandibular Advancement Surgery: Postoperative Plate Bending Following Emergency Intubation. J Craniofac Surg 2024:00001665-990000000-01368. [PMID: 38385679 DOI: 10.1097/scs.0000000000010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024] Open
Abstract
Maxillomandibular advancement surgery is a recognized technique for the management of obstructive sleep apnea. Complications for this surgery are not well-documented in the literature. The authors report an unusual case of mandibular plate bending following unplanned postoperative airway management using an oral endotracheal tube in a 65-year-old male. The bent mandibular plate and airway concern required a return to the theater for the replacement of bent plates and tracheostomy placement. This case documents the importance of multidisciplinary team planning for airway-related surgery as well as the need for multidisciplinary team management of postoperative airway management following orthognathic surgery.
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Affiliation(s)
- Emily Lightfoot
- Department of Oral and Maxillofacial Surgery, The University of Queensland, Brisbane
| | - Emilija D Jensen
- Discipline of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, SA, Australia
| | - Sanjaya N Gamage
- Discipline of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, SA, Australia
| | - Andrew H Cheng
- Discipline of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, SA, Australia
| | - Paul J Sambrook
- Discipline of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, SA, Australia
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Liu K, Luo S, Wang X, Cao J, Guo Y, Zhang Y, Li B, Zhang L, Wang X. Objective assessment of visual attention in orthognathic surgery training based on eye tracking. J Craniomaxillofac Surg 2024; 52:65-70. [PMID: 37884435 DOI: 10.1016/j.jcms.2023.08.017] [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: 10/28/2022] [Revised: 01/13/2023] [Accepted: 08/23/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this study was to investigate the differences in visual attention between novices and orthognathic experts, as well as to provide evidence for use in developing and optimizing training strategies for orthognathic surgery. Novice and orthognathic experts were recruited, and their distributions of visual attention were monitored via an eye-tracking device while they watched orthognathic surgery videos. The percentages of visual fixation duration devoted to the areas of interest - surgical objects, instruments controlled by the main surgeon, and instruments controlled by the assistants - in each orthognathic surgery section were analyzed and compared between the two groups using repeated-measures factorial analysis of variance (ANOVA). In total, there were 18 participants, comprising both novices (n = 9) and experts (n = 9). For all sections of orthognathic surgery, the percentage of fixation duration on surgical objects was significantly higher for the novices than for the experts (p = 0.031, p = 0.005, p = 0.026, p = 0.047, p = 0.047, p = 0.031, p = 0.027, p = 0.034, p = 0.008, and p = 0.016). During the maxillary segment separation as part of Le Fort I osteotomy and the splitting of the mandible as part of bilateral sagittal split osteotomy, the novices also had a higher percentage of fixation duration on the instruments controlled by the main surgeon, as compared with the experts (p = 0.007 and p = 0.048, respectively). Novices invested great cognitive effort into the surgical objects in each section of orthognathic surgery, including the instruments controlled by the main surgeon in the maxillary segment separation and the splitting of the mandible. Strengthening this aspect of instruction could help novices reduce their cognitive load and achieve mastery more efficiently.
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Affiliation(s)
- Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Songyuan Luo
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xinxi Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Cao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yuxiang Guo
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yujie Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Balel Y. The Last 40 Years of Orthognathic Surgery: A Bibliometric Analysis. J Oral Maxillofac Surg 2023:S0278-2391(23)00317-8. [PMID: 37075807 DOI: 10.1016/j.joms.2023.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Bibliometric analyses provide information on the effectiveness, performance, trends, and various other characteristics of research by using mathematical and statistical analysis methods for data related to scientific publications. This study aims to determine the focus of studies in the field of orthognathic surgery, map it, and present the results in a simplified manner through a comprehensive bibliometric analysis of the relevant literature. METHODS In this bibliometric analysis study, orthognathic surgery publications from 1980 to 2022 were retrieved from the Web of Science Core Collection database. The independent variables were co-citations, while the outcome variables included cross-country collaboration analysis, keyword analysis, co-citation analysis, and cluster analysis of the co-citation network. Covariates were the number of publications, number of citations, year range, centrality value, and silhouette value. The bibliometric analysis was conducted using CiteSpace, VOSviewer, and R-Studio software. RESULTS A total of 7,135 publications and 75,822 references were included in the analysis, and the annual growth rate of publications was 9.52%. The co-citation clustering analysis revealed that the orthognathic surgery literature was organized into 16 subject headings. Patient satisfaction was found to be the most widely published topic. The youngest clusters, representing new topics in the field, were virtual planning and examination of condylar changes after orthognathic surgery. CONCLUSION Bibliometric analysis methods were used to evaluate the 40-year history of the orthognathic surgery literature. The analysis identified the most influential publications, the topics in which the literature is divided, and hot spots in the field. By conducting similar bibliometric research studies in the future, the progress and future direction of the literature can be monitored based on evidence.
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Affiliation(s)
- Yunus Balel
- Consultant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkey.
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Correlation between mandibular anatomy and bad split occurrence during bilateral sagittal split osteotomy: a three-dimensional study. Clin Oral Investig 2023; 27:1035-1042. [PMID: 35953564 DOI: 10.1007/s00784-022-04665-w] [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: 06/09/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to find out the correlation between different anatomical parameters of the mandible and the occurrence of a bad split in patients who had undergone bilateral split sagittal ramus osteotomy (BSSRO). MATERIALS AND METHOD At both the distal roots of the first molar (1) and the retromolar area (2), we measured the distance from the buccal margin of the inferior dental canal (IDC) to the buccal margin of the cortical bone (MCBC), the thickness of both buccal cortical (WBCB) and cancellous bone (WBCA), distance from the superior border of IDC to the alveolar crest (MCAC), buccolingual thickness (BLT), and thickness of cancellous bone (WCA). At the ramus, the distances between the sigmoid notch to the upper part of the lingula (SL) and the inferior border of the mandible (SIBM), the thickness of the ramus at the level of the lingula (BLTR), and the anteroposterior width of the ramus (APWR) were measured. The paired and independent t-tests were used when applicable, and a P-value < 0.05 was considered significant. RESULTS MCBC1 showed a significant difference between bad and non-bad split sides (P = 0.037). Both WBCA1 and WBCA2 show the same significant difference (P = 0.023, 0.024). Similarly, WCA1 and WCA2 showed a statistical difference between the bad and non-bad split sides (P = 0.027, 0.036). There were no statistically significant differences between the compared sides of WBCB1, WBCB2, MCAC1, MCAC2, SIBM, APWR, SL, and BLTR. CONCLUSION Narrow space between IDC and the buccal cortical margin, along with the decrease in the thickness of both buccal cancellous bone and total cancellous bone at the inferior border of the mandible along the course of SSRO, has been implicated in the occurrence of bad split intraoperatively.
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National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients. J Craniofac Surg 2023:00001665-990000000-00562. [PMID: 36804875 DOI: 10.1097/scs.0000000000009188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO) have unique operative challenges and inherent anatomic considerations that predispose to certain adverse outcomes, yet their respective complication profiles continue to be debated given conflicting results from single-center investigations. The purpose of this study is to perform a multi-institutional analysis of complications, socioeconomic trends, and financial charges associated with orthognathic surgery. METHODS A retrospective cohort study was conducted of orthognathic procedures performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Patients younger than 12 years of age were excluded. Medical complications, surgical complications, and admission costs were compared across procedures. Socioeconomic determinants and trends across regions of the country were also analyzed. RESULTS During the study interval, 6640 patients underwent orthognathic surgery, including LF1 (59.2%, n=3928), BSSO (14.4%, n=959), and double-jaw surgery (26.4%, n=1753). Patients undergoing LF1 were more likely to experience overall complications (P<0.001), infections (P<0.001), and blood transfusions (P<0.001) than those undergoing BSSO. High-volume hospitals were more likely to perform double-jaw procedures than other hospitals (P<0.001), yet high-volume hospitals were less likely to have surgical complications (P=0.014). Patient admission charges related to orthognathic operations at high-volume hospitals were less than other hospitals (P<0.001). Household income was higher for orthognathic procedures performed at high-volume hospitals (P<0.001). White patients were 1.5 times more likely to choose a farther, higher volume hospital for orthognathic surgery than the one locally available (P=0.041). CONCLUSIONS LeFort I osteotomy procedures had higher infection and transfusion rates than BSSO procedures. High-volume hospitals were more likely to perform double-jaw procedures, yet high-volume hospitals had fewer complications and decreased admission charges. Future study will be needed to further elucidate case-mix index details and socioeconomic determinants of health contributing to these disparities.
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Hattori Y, Lo LJ. Facial palsy after orthognathic surgery: A systematic review. J Craniomaxillofac Surg 2023; 51:52-59. [PMID: 36702655 DOI: 10.1016/j.jcms.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
It was the aim of the systematic review to evaluate the incidence of facial palsy following orthognathic surgery, and to assess the possible mechanisms of injury, subsequent management, and eventual outcomes. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. A thorough search of PubMed, Scopus, Cochrane Library, and CINAHL databases up to April 2022 was conducted. In total, 34 articles were selected for this review, including 54 facial palsies in 53 patients. The incidence of facial palsy was estimated to range from 0.04% to 0.77%. Most of the possible etiologies proposed involved intraoperative nerve compression or postoperative edema. Physical therapy and steroid administration were the most frequently employed management approaches. Surgical exploration for the facial nerve was executed in one patient. Forty-three facial palsies (79.6%) attained complete recovery with conservative management, whereas 11 facial palsies (20.4%) continued to show incomplete recovery during the follow-up period. Earlier facial palsy onset (timing after surgery) was related to a higher risk of continuing palsy (p = 0.018). Within the limitations of this review it seems that facial palsy following orthognathic surgery should be treated conservatively whenever appropriate.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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12
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The use of an ultrasonic curettage device in orthognathic surgery decreases surgery-related blood loss. Heliyon 2022; 8:e12639. [PMID: 36636227 PMCID: PMC9830166 DOI: 10.1016/j.heliyon.2022.e12639] [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: 07/14/2022] [Revised: 09/29/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to compare the use of a powered instrument (PI) and ultrasonic curettage device (ULCD) with intraoperative blood loss (IOBL), drain volume (DV), calculated blood loss (CBL), and hidden blood loss (HBL) in orthognathic surgery. Methods We included 163 patients who underwent bimaxillary surgery in our department. CBL was calculated from the preoperative and postoperative hemoglobin levels using the "hemoglobin balance method." CBL is an indicator of the amount of perioperative blood loss. HBL was calculated by subtracting IOBL and DV from CBL. Results The PI group consisted of 61 patients (17 males and 44 females, age: 24.9 ± 9.5 years), and the ULCD group consisted of 102 patients (40 males and 62 females, age: 23.1 ± 7.8 years). In the PI group, the median IOBL, DV, CBL, and HBL were 540.0 (interquartile range [IQR] 380.0-670.0), 113.0 (IQR 77.0-147.0), 1000.0 (IQR 751.4-1248.6), and 285.8 (IQR 151.0-476.4) ml, respectively. In the ULCD group, the median IOBL, DV, CBL, and HBL were 327.5 (IQR 200.0-455.0), 105.5 (IQR 75.3-136.0), 759.5 (IQR 594.9-944.2), and 294.2 (IQR 120.8-456.9) ml, respectively. IOBL and CBL were significantly reduced with ULCD use, but no significant differences were observed in DV and HBL. Conclusions This study showed that IOBL decreased with ULCD use, resulting in a decrease in CBL. Conversely, bleeding parameters (DV and HBL), which reflect the amount of bleeding that occurs after wound closure, did not show a decrease with ULCD use.
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Togninalli D, Antonarakis GS, Schatz JP. Condylar resorption following mandibular advancement or bimaxillary osteotomies: A systematic review of systematic reviews. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e948-e955. [PMID: 35263683 DOI: 10.1016/j.jormas.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery.
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Affiliation(s)
- David Togninalli
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Gregory S Antonarakis
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Paul Schatz
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
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Afifah N, Maulina T, Yuza AT. Management of A Bad Split Complication: A Systematic Review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2204181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Bad split is one of the well-known intra-operative complications that occur during the bilateral sagittal split osteotomy (BSSO) procedure, which is a rehabilitation procedure for patients with mandibular deformities. The prevention of further post-surgery complications required sufficient management of bad split complications.
Objective:
This study aimed to analyze the management of bad split complications during a BSSO procedure.
Methods:
The literature review was conducted in the form of library research in the field of bad split complications' management by a BSSO based on the Preferred Reporting Items for Systematic Reviews (PRISMA). Related studies were found through using a manual search using Pubmed, ScienceDirect, Ebscohost, Scopus, Medline, Embase, and Web of Science, among other search engines. The inception of incorporation standards, the process of data extraction, and the determination of the risk of bias were carried out by the authors. The process of data screening was conducted by applying the inclusion and exclusion criteria.
Results:
This paper systematically reviewed seven related studies, four of which were case series and two of which were cross-sectional. The utilization of additional osteosynthetic plates was revealed throughout the extraction process as the most acquainted course of action to manage the bad split complications during the BSSO procedure.
Conclusion:
The osteosynthetic plate and miniplate application with bicortical or monocortical screws were exposed as the most used treatment for bad split complications.
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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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Gutiérrez-Santamaría J, Simon D, Capitán L, Bailón C, Bellinga RJ, Tenório T, Sánchez-García A, Capitán-Cañadas F. Shaping the Lower Jaw Border with Customized Cutting Guides: Development, Validation, and Application in Facial Gender-Affirming Surgery. Facial Plast Surg Aesthet Med 2022. [PMID: 35349332 DOI: 10.1089/fpsam.2021.0418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Three-dimensional planning software is not standardized in facial gender-affirming surgery. Objective: To develop and validate surgical planning software to create cutting guides to contour the lower jaw border. Design, Setting, and Participants: A 3-year prospective case series study done in three phases: software development, validation, and surgical guide application. Ethics committee approval was obtained to enroll the patients (Clinical Research Ethics Committee, Hospital Costa del Sol, Marbella, Spain). Main Outcomes and Measures: Validation phase: degree of agreement between the planned and obtained results, modification of cephalometric parameters, and surgical times. Application phase: surgical technique description, complications, and patient-reported outcome measures. Results: The degree of agreement between the planned and obtained results was inframillimetric (0.31 ± 0.70 mm). The guides reduced the mandible to within feminine parameters (p < 0.05). Surgical times decreased by 10.96% with chin ostectomies (p < 0.05) and 23.06% with lower jaw border (angle-to-angle) surgeries (p < 0.001). In the application phase, revision surgery was required for 11 patients out of 260 (4.23%). Conclusions and Relevance: The use of cutting guides on the lower jaw border is effective, helps reach standard feminine parameters, and decreases surgical times.
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Affiliation(s)
| | - Daniel Simon
- The Facialteam Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Luis Capitán
- The Facialteam Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Carlos Bailón
- The Facialteam Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Raúl J Bellinga
- The Facialteam Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Thiago Tenório
- The Facialteam Group, HC Marbella International Hospital, Marbella, Málaga, Spain
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Bilateral Mandibular Pseudoarthrosis: A Rare Complication after Orthognathic Surgery. J Craniofac Surg 2022; 33:e569-e572. [PMID: 35148528 DOI: 10.1097/scs.0000000000008485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orthognathic surgery to treat dentofacial discrepancies has become an increasingly common elective procedure in surgical practices. Despite its numerous advantages such as improved aesthetics and masticatory and respiratory function, some complications and unfavorable results can be observed. Pseudoarthrosis after orthognathic surgery is a rare complication and is little reported in the literature. Pseudoarthrosis is characterized by an increasing occlusal worsening associated with bone mobility and pain. Due to the low incidence of pseudoarthrosis, it is necessary to study its involvement to elucidate its etiology and treatment. The aim of this work was to report a clinical case of bilateral mandibular pseudoarthrosis after orthognathic surgery, where multiple interventions and prolonged treatment time were necessary until the case was concluded. The precise diagnosis associated with the choice of the most effective treatment based on the literature proved to be essential for the management of this complication.
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Do lower third molars increase the risk of complications during mandibular sagittal split osteotomy? Systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 51:906-921. [DOI: 10.1016/j.ijom.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
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Classification and Clinical Treatments for Unfavorable Fractures of the Proximal Segment in Sagittal Spilt Ramus Osteotomy: A Retrospective Study of 964 Cases. J Craniofac Surg 2021; 33:1445-1449. [PMID: 34629384 DOI: 10.1097/scs.0000000000008276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Unfavorable fractures in sagittal split ramus osteotomy are hard to manage. The aim of this study is to develop a new classification method for unfavorable fractures of the proximal segment to guide clinical managements. After reviewing 964 cases of sagittal split ramus osteotomy, we found that the unfavorable fractures can be divided into 3 types: mandibular ramus transverse fractures (Type 1), bad fractures accompanied by free fragments (Type 2), and unexpected separation patterns without free fragments (Type 3). We calculated the incidence of each fracture type and provided instructions for their corresponding treatments. Thirty-six patients suffered from unfavorable fractures (7.4% of patients), among which 32 patients had unilateral fractures and 4 patients had bilateral fractures. There were 2 Type 1 fractures (0.2% of split sites), 8 Type 2 fractures (0.8% of split sites), and twenty-six Type 3 fractures (2.3% of split sites). Type 1 unfavorable fractures are difficult to deal with, but Types 2 and 3 are generally manageable and they have no significant impact on the final outcomes. The new classification can effectively guide treatment strategies for unfavorable fractures. Severe cases of unfavorable fractures are rare, and most unfavorable fracture cases have a positive prognosis if correctly treated in time.
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The neurosensory deficit of inferior alveolar nerve following bilateral sagittal split osteotomy: a prospective study. Oral Maxillofac Surg 2021; 26:401-415. [PMID: 34510239 DOI: 10.1007/s10006-021-01005-2] [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: 05/10/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Investigation in Saudi Arabia or the Arab Gulf States to assess the unfavorable impacts of the bilateral sagittal split osteotomy (BSSO) is non-existent, so questions have been raised about the success rate of this operation and the frequency of unwilling outcome. To address these worries, we directed a case series study to evaluate the hypoesthesia, a type of neurosensory deficit (NSD) of the inferior alveolar nerve (IAN) after BSSO, and if the hypoesthesia outcome will improve if the surgeries performed by a single surgeon. PATIENTS AND METHODS This was a prospective case series study for the patient who underwent BSSO in a medical complex that is considered one of the largest in Saudi Arabia (Riyadh). The inclusion criteria include patient aged 18-40 years, any gender, and American Society of Anesthesiologists (ASA) class I. They will undergo BSSO for either mandibular, retrognathia, prognathic, or to follow the maxilla. The outcome will be measured after evaluating the neurosensory by four means light touch (LT), pinprick (PP), 2-point discrimination (2PD), and thermal sensations (TT) in four repeated measurements (preoperatively, 1 week, 1 month, 3 months postoperatively) as the primary outcome. Other confounding factors were the secondary outcome (age, gender, visualization of the I.A.N, the type of mandibular movement, split favorability, mandibular canal location, and patient reports about paresthesia or dysesthesia on any given side); these data analyses were carried out using SPSS ver. 25 data processing software. RESULTS The nerve was visible in 93% of cases. During the operation, none of the nerves was transected. Hypoesthesia on the first follow-up was 94% of cases for LT, 92% for PP, 82% for TT, and 100% for the 2PD. On the last follow-up, the patients still had hypoesthesia for the LT 51%, PP 35%, TT41%, and 2PD 55%; age and sex did not significantly affect hypoesthesia outcomes. Nerve visibility and inferior alveolar nerve canal (IAC) distance did not influence the results. The level of confidence for all tests was set at p < 0.05. CONCLUSIONS The 2PD sensation was the most affected sense on the last visit, and the right side of the chin and lower lip was affected most both on early and long-term follow-up due to several reasons. A 3-month period was enough as a recovery time to restore 100% of neurological sensation for 45% of the sample, which is similar to several studies in the literature. A single surgeon did not show superior result compared to two surgeons' literature papers. Advancement movement was associated with a high percentage of hypoesthesia.
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Bachaoui SE, Dobbeleir M, De Ketele A, Politis C. Spontaneous bilateral coronoid process fracture of the mandible after BSSO: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e62-e64. [PMID: 34329802 DOI: 10.1016/j.jormas.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
A patient with spontaneous bilateral fracture of the mandibular coronoid process is presented. The definite cause is unknown, but possible contributing factors include osteoporosis, bruxism and changed kinetics of the temporalis muscle after bilateral sagittal split osteotomy (BSSO) resulting in an avulsion fracture. The patient was treated surgically with bilateral coronoidectomy.
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Affiliation(s)
- Samy El Bachaoui
- Faculty of Medicine, KU Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, Leuven 3000, Belgium.
| | - Matthias Dobbeleir
- Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, Leuven 3000, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
| | - Astrid De Ketele
- Faculty of Medicine, KU Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, Leuven 3000, Belgium.
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Head of Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
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22
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Pediatric Orthognathic Surgery: National Analysis of Perioperative Complications. J Craniofac Surg 2021; 32:e798-e804. [PMID: 34238876 DOI: 10.1097/scs.0000000000007843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Orthognathic surgery has traditionally been performed after skeletal maturity. Although these procedures are also being performed in children, the implications of earlier intervention and specific risk factors in this younger population remain unknown. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for orthognathic procedures performed in 2018. Complications, readmissions, and reoperations were analyzed with appropriate statistics. RESULTS Overall adverse event rate after orthognathic surgery in pediatric patients was 7.8% (n = 22 of 281), which were associated with having any comorbidity (P < 0.001), overall respiratory comorbidities (P = 0.004), structural pulmonary abnormality (P < 0.001), developmental delay (P = 0.035), structural central nervous system abnormality (P < 0.001), and neuromuscular disorder (P = 0.035). Most common complications were excessive bleeding (2.5%), surgical site infection (1.1%), and pneumonia (0.7%). Orthognathic surgery in children below 6 years of age is associated with significantly increased adverse events (P < 0.001), including surgical site infection (P < 0.001), pneumonia (P = 0.022), readmission (P < 0.001), and reoperation (P < 0.001). Le Fort I osteotomies (P < 0.001) and bilateral sagittal split osteotomies (P = 0.009) took significantly longer for older patients in the years of permanent dentition than younger patients in the years of deciduous dentition. Single- and double-jaw procedures in pediatric patients have similarly low adverse events (P all ≥0.130). Interestingly, bilateral sagittal split osteotomies performed before 13.5 years of age were associated with a higher risk of adverse events (P = 0.012), such that these younger patients were 7.1 times more likely to experience adverse events if their procedure was performed earlier. CONCLUSIONS Orthognathic surgery is relatively safe, but children in the years of deciduous dentition under 6 years of age have significantly increased risk of adverse events.
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Kasahara N, Matsunaga S, Yamamoto M, Morita S, Odaka K, Abe S, Yamamoto H. Comparative Study of Morphology and Distribution of Valves in Human Retromandibular Vein. THE BULLETIN OF TOKYO DENTAL COLLEGE 2021; 62:99-106. [PMID: 33994425 DOI: 10.2209/tdcpublication.2020-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to analyze the distribution and morphology of the valves in the human retromandibular vein. The retromandibular, internal thoracic, azygos, femoral, and brachial veins were harvested from 46 cadavers donated to the Department of Anatomy at Tokyo Dental College for dissection. The frequency of the valves in each vein, the length of the cusps, and the thickness of the vein itself were measured. Valves were present at high frequency (92.1%) in the veins of the limbs and had cusps at least twice as long as the internal diameter of the vein. Veins in the trunk contained a lower frequency of valves, with cusps that tended to be shorter (1.60±0.77) than those of the venous valves in the limbs (2.12±0.60). The valves of the retromandibular vein tended to resemble venous valves in the trunk in terms of both frequency and morphology. The main function of venous valves in the limbs is to prevent retrograde flow. Conversely, valves in the veins of the trunk and retromandibular vein play a role in retaining blood in the veins, and their relationship to other veins means that they can cause major hemorrhage.
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Affiliation(s)
- Norio Kasahara
- Department of Histology and Developmental Biology, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Masahito Yamamoto
- Department of Anatomy, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Sumiharu Morita
- Department of Anatomy, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Kento Odaka
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
| | - Hitoshi Yamamoto
- Department of Histology and Developmental Biology, Tokyo Dental College.,Oral Health Science Center, Tokyo Dental College
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Hamada H, Kawase-Koga Y, Hasegawa O, Watanabe M, Chikazu D. Skeletal prognathism with factor XII deficiency causing complications in perioperative management: A case report. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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A comparison and evaluation of the use of ultrasonic cutting devices with conventional powered instruments in orthognathic surgery. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bilateral sagittal split osteotomy training on mandibular 3-dimensional printed models for maxillofacial surgical residents. Br J Oral Maxillofac Surg 2020; 58:953-958. [DOI: 10.1016/j.bjoms.2020.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/27/2020] [Indexed: 01/10/2023]
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Lutz JC, Assouline Vitale LS, Graillon N, Foletti JM, Schouman T. Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation. J Oral Maxillofac Surg 2020; 78:1832.e1-1832.e12. [PMID: 32574606 DOI: 10.1016/j.joms.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Conventional orthognathic osteotomies provide appropriate functional outcomes but might be unable to correct midface deficiency, achieve a satisfactory outcome in asymmetrical cases, or allow sufficient chin advancement. We evaluated the outcome of both standard and customized facial high-density porous polyethylene implants used to refine the cosmetic outcome of orthognathic surgery. PATIENTS AND METHODS We implemented a retrospective study. The sample was composed of all patients who underwent facial alloplastic augmentation between June 2011 and October 2018 in our department. The complication rate was recorded after a mean follow-up period of 41 months postoperatively, and patient satisfaction was assessed through a qualitative evaluation based on an 11-item questionnaire. RESULTS The sample was composed of 24 implants placed in 14 patients: 13 mandibular angle implants, among which 4 were customized; 8 malar implants; and 3 chin implants. No physical complications such as hematoma, infection, migration, or hypoesthesia were observed. Two implants had to be removed because of early unsatisfactory esthetic outcomes. Of 14 patients, 11 answered our questionnaire. Eighty-two percent strongly agreed that the overall outcome was satisfactory. CONCLUSIONS The results of this study confirm the low physical complication rate described in the literature, and the esthetic complication rate remains lower than the rates observed in previous reports. A high satisfaction rate was found among patients. The lowest mean satisfaction score was noted for appropriate implant symmetry (3.5), whereas the highest mean satisfaction score (3.8) was achieved when using customized implants. If standard high-density porous polyethylene implants appear to be relevant adjuncts to orthognathic surgery, customized implants seem to achieve higher satisfaction, although their prohibitive cost should be considered.
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Affiliation(s)
- Jean-Christophe Lutz
- Associate Professor, Maxillo-Facial and Plastic Surgery Department, Strasbourg University Hospital, Strasbourg, France; Faculty of Medicine, University of Strasbourg, Strasbourg, France; and Laboratory of Engineering Science, Computer Science and Imaging, National Center for Scientific Research (CNRS), ICUBE University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Strasbourg, France.
| | | | - Nicolas Graillon
- Chief Resident, Oral and Maxillofacial Surgery Department, Aix Marseille University, Public Assistance Hospitals of Marseille (APHM), French Institute for Science and Technologies in Transportation, Spatial Planning and Networks (IFSTTAR), Applied Biomechanics Laboratory (LBA), CHU Conception, Marseille, France
| | - Jean-Marc Foletti
- Associate Professor, Oral and Maxillofacial Surgery Department, Aix Marseille University, Public Assistance Hospitals of Marseille (APHM), French Institute for Science and Technologies in Transportation, Spatial Planning and Networks (IFSTTAR), Applied Biomechanics Laboratory (LBA), CHU Conception, Marseille, France
| | - Thomas Schouman
- Associate Professor, Oral and Maxillofacial Surgery Department, Public Assistance Hospitals of Paris (APHP)-Pitié-Salpetrière University Hospital, Paris, France; and Sorbonne University, UPMC Paris 06 University, Paris, France
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Hu J, Song Y, Wang D, Yuan H, Jiang H, Cheng J. Patterns of lingual split and lateral bone cut end and their associations with neurosensory disturbance after bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:595-601. [DOI: 10.1016/j.ijom.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
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29
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How does bone thickness affect the split pattern of sagittal ramus osteotomy? Int J Oral Maxillofac Surg 2020; 49:218-223. [DOI: 10.1016/j.ijom.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/15/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
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Dysphagia Requiring Nasogastric Feeding Following Orthognathic Surgery: An Unusual Complication, Case Report, Literature Review, and Recommendations. J Oral Maxillofac Surg 2019; 77:601-606. [DOI: 10.1016/j.joms.2018.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
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Bacos J, Turin SY, Vaca EE, Gosain AK. Major Complications and 30-Day Morbidity for Single Jaw Versus Bimaxillary Orthognathic Surgery as Reported by NSQIP. Cleft Palate Craniofac J 2018; 56:705-710. [PMID: 30497282 DOI: 10.1177/1055665618814402] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Acute complications in orthognathic surgery are reported in single-institution studies with small sample sizes. We aimed to analyze risk factors for acute complications using a national data set to better inform surgical decision-making. METHODS 2005-2015 National Surgical Quality Improvement Program (NSQIP) data sets were analyzed for patients undergoing Le Fort 1 and/or bilateral sagittal split osteotomies (BSSO) for nontraumatic indications. Demographics, comorbidities, medical, and surgical 30-day complications were tabulated. A logistic regression model was used to determine predictors of complications. RESULTS Five hundred eight patients met the inclusion criteria: 228 underwent Le Fort I osteotomies, 152 BSSO, and 128 patients underwent both during a single surgical encounter. Overall complication rate was 4.5% (23/508). Superficial infection was the most common complication (11 in BSSO and 2 in Le Fort I cohorts). Increasing age and undergoing BSSO alone were associated with higher overall complication rates (P < .05) and surgical complications specifically (P < .05). Patients undergoing the combined procedure had shorter operative time (208 minutes) than the times for Le Fort I osteotomies alone (177 minutes) and BSSO alone (155 minutes) added together and did not have a longer hospital stay (P = .608) or increased need for transfusion (P = 1.0) compared to the surgeries being done separately. CONCLUSION This is the first complication risk factor analysis for Le Fort I osteotomy and BSSO using the multi-institutional NSQIP data set. Combining BSSO and Le Fort I osteotomy leads to a shorter overall operative time and does not increase hospital stay duration or 30-day complication rate when compared to the 2 procedures being done separately.
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Affiliation(s)
- Jonathan Bacos
- 1 Division of Plastic and Reconstructive Surgery, Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Sergey Y Turin
- 1 Division of Plastic and Reconstructive Surgery, Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Elbert E Vaca
- 1 Division of Plastic and Reconstructive Surgery, Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- 1 Division of Plastic and Reconstructive Surgery, Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Dislodged Bonded Molar Tube into Wound during Orthognathic Surgery. Case Rep Dent 2018; 2018:6540945. [PMID: 29971169 PMCID: PMC6009024 DOI: 10.1155/2018/6540945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/28/2018] [Accepted: 04/15/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Dislodgement of orthodontic appliance into operation wounds may occur while performing orthognathic surgery. Its occurrence is commonly associated with bonded upper molar tube. Case Report A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure. Conclusion Dislodged metal orthodontic appliance in oral wound acts as a foreign body that may exert allergic reactions, infection, or inflammation. Pre- and postoperative intraoral examination of fixed orthodontic appliances including its count should be recorded in orthognathic surgery protocol.
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Santos FT, Sciescia R, Santos PL, Weckwerth V, Dela Coleta Pizzol KE, Queiroz TP. Is Low-Level Laser Therapy Effective on Sensorineural Recovery After Bilateral Sagittal Split Osteotomy? Randomized Trial. J Oral Maxillofac Surg 2018; 77:164-173. [PMID: 30599885 DOI: 10.1016/j.joms.2018.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE When performing a sagittal osteotomy of the mandibular ramus, one must consider the risk of long-term postsurgical sensory abnormalities from lesions to the inferior alveolar nerve. One treatment for these changes is low-level laser therapy (LLLT). Thus, the aim of this research was to evaluate the effectiveness of LLLT on sensorineural recovery after split ramus osteotomy of the mandible. MATERIALS AND METHODS This randomized, double-blinded, split-mouth design trial included patients who underwent advanced surgery of the mandible and then received LLLT on 1 side of the mandible (experimental) and a random placebo (control) treatment on the opposite site. Patients were divided into 2 groups: group 1 was treated during the short postoperative period (within 30 days) and group 2 was treated for persistent sensory abnormalities during the late postoperative period (6 months to 1 yr). Each patient received 5 LLLT and control sessions with intervals of 3 to 4 weeks between sessions. The experimental side in each patient received LLLT in the extraoral area (mandibular ramus and entire length of the inferior alveolar nerve to the mental region) and the intraoral area (mental foramen region). The control side received simultaneous placebo treatments. The sensorineural response was analyzed before the onset of treatment and after each LLLT and control session using the Semmes-Weinstein monofilament test. RESULTS Twenty adult patients (mean age, 35.6 years; 70.0% women) showed improvement in the experimental and control sides during the follow-up period. However, the experimental side in groups 1 and 2 exhibited a marked improvement in sensorineural recovery over the course of the sessions, and group 1 had the best results. CONCLUSION LLLT was effective in the recovery from sensorineural disorders after orthognathic surgery during the short postoperative period, particularly in the fifth session.
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Affiliation(s)
- Fagner Teixeira Santos
- Surgeon-Dentist, Private Clinic and University of Araraquara (UNIARA), Araraquara, SP, Brazil
| | - Rodrigo Sciescia
- Surgeon-Dentist, Private Clinic and University of Araraquara (UNIARA), Araraquara, SP, Brazil
| | - Pâmela Leticia Santos
- Professor, Department of Health Sciences, Implantology Post Graduation Course, Dental School, University Center of Araraquara, UNIARA, Araraquara, SP, Brazil.
| | - Vitor Weckwerth
- Surgeon-Dentist, Private Clinic and University of Sagrado Coração (USC), Bauru, SP, Brazil
| | - Karina Eiras Dela Coleta Pizzol
- Professor, Department of Health Sciences, Orthodontics Post Graduation Course, Dental School, University Center of Araraquara, UNIARA, Araraquara, SP, Brazil
| | - Thallita Pereira Queiroz
- Professor, Department of Health Sciences, Implantology Post Graduation Course, Dental School, University Center of Araraquara, UNIARA, Araraquara, SP, Brazil
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Relationship Between the Quantity of Nerve Exposure During Bilateral Sagittal Split Osteotomy Surgery and Sensitive Recovery. J Craniofac Surg 2018; 28:1375-1379. [PMID: 28489659 DOI: 10.1097/scs.0000000000003606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM AND OBJECTIVES The purpose of this study was to evaluate how different exposures of the V3 nerves during orthognathic surgery impact neurosensory disturbances. METHODS The study included 127 patients who underwent either bilateral sagittal split osteotomy (BSSO) or BSSO with maxillary le Fort 1. They were divided into 6 groups, identified by the quantity of V3 nerve exposure. All patients were examined in a pre-op period and again after 1, 3, 6 months post-op. The standardized tests used were to clarify the objective and subjective neurosensory status of the exposed nerve. Neurosensory evaluation included; a pin prick test, the 2 points discriminator, light touch, warm and cold tests, and blunt discrimination. They were all done bilaterally on the lower lip area. RESULTS In only 2 patients the nerve was damaged during surgery and thus they were not included in this study. In 10.2% of patients there was no nerve exposure, 25.2% had longitudinal vestibular segment nerve exposed, 22.8% had the longitudinal upper-vestibular segment exposed, 20.5% had the longitudinal lower-vestibular segment exposed, 14.2% had the longitudinal upper-lower-vestibular segment exposed, and in 7.1% of patients the nerve was totally exposed. Given the estimated time of 1 month there was 100% recovery in patients whose nerve was unexposed. Considering the other patients, the authors had a variable number of patients who did not recover completely. CONCLUSION The authors estimate a correlation between the recovery time and the quantity of the exposed nerve. There is a high incidence of neurosensory disturbance in the lower lip and chin after BSSO and intraoperative quantity of nerve exposure.
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Osteotomy Site Grafting in Bilateral Sagittal Split Surgery With Bioactive Glass S53P4 for Skeletal Stability. J Craniofac Surg 2017; 28:1709-1716. [PMID: 28962090 DOI: 10.1097/scs.0000000000003760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In orthognathic surgery, the aim of the treatment is to achieve a good occlusion and a satisfying aesthetic outcome. In large mandibular advancements insufficient healing at the mandibular inferior border may lead to loss of support for the overlaying tissue at the osteotomy site. Augmentation can be performed to improve stability, bone regeneration, and the aesthetic outcome. The purpose of this prospective clinical study was to evaluate the use of a novel material for this indication; granules of the antibacterial, osteoconductive, and slowly resorbing bioactive glass S53P4 as filling material in large mandibular advancement in bilateral sagittal split osteotomies. The authors treated 25 patients who underwent bilateral sagittal split osteotomies due to class II dentoskeletal deformities. The mandibular osteotomy site defects (8-15 mm) were augmented with bioactive glass S53P4. The average clinical follow-up was 33 months and the average radiological follow-up with cone beam computerized tomography was 24 months. The clinical and radiological results were good with regard to healing, bone regeneration, and stability of the osteotomy sites. The recontouring of the inferior mandibular border provided a good soft tissue support followed by an excellent aesthetic outcome in 96% of the osteotomy sites. The occlusion was stable in 88% of the patients. The authors' results show that bioactive glass S53P4 is a safe grafting material for osteotomy site defects in significant mandibular advancements with reliable bone regeneration, providing long-term stability at the osteotomy site and at the inferior mandibular border.
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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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Gupta A, Chowdhury R, Haring RS, Leinbach LI, Petrone J, Spitzer MJ, Schneider EB. Length of Stay and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter? J Oral Maxillofac Surg 2017; 75:1948-1957. [PMID: 28576668 DOI: 10.1016/j.joms.2017.04.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The relations among procedure-specific annual surgeon volume, hospital length of stay (LOS), and hospital costs for patients undergoing the 2 most common orthognathic surgical (OGS) procedures, segmental osteoplasty or osteotomy of the maxilla (SOM) or open osteoplasty or osteotomy of the mandibular ramus (SOMR), are not known. The authors hypothesized that treatment by high-volume surgeons would be associated with decreased LOS and costs. MATERIALS AND METHODS All patients 8 to 64 years old who underwent elective SOM or SOMR were selected from the 2001 to 2009 Nationwide Inpatient Sample. Patients with missing vital status or payment mode status or who underwent more than 1 OGS procedure during the index hospitalization were excluded. Based on year- and procedure-specific annual surgeon volumes, the highest (highest quartile) and lowest (lowest quartile) procedure volume surgeon groups were compared. Multivariable logistic regression was used to study the relation between surgeon volume and extended patient LOS (defined as LOS ≥ 75th percentile). Generalized linear models with a log-link and gamma distribution were used to examine the association between surgeon volume and hospital costs. Models were adjusted for patient- and hospital-level factors and type of procedure (SOM or SOMR). Analysis was weighted to represent national-level estimates and an α value of 0.05 was used for all comparisons. RESULTS After weighting to the population level, 8,062 patients were included for study. Most were white (80.6%), female (61.4%), and privately insured (84.6%). Mean age was 26 years (standard deviation, 0.38 yr). After adjusting for potential confounders, patients treated by high-volume surgeons showed 40% lower odds of extended LOS (odds ratio = 0.60; 95% confidence interval [CI], 0.38-0.95; P = .032) and incurred substantially lower costs (-$1,484.74; 95% CI, -2,782.76 to -185.58; P = .025) compared with patients treated by low-volume surgeons. CONCLUSION These findings suggest that regionalization of patients to high-volume surgeons for OGS procedures could decrease LOS and incurred costs.
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Affiliation(s)
- Avni Gupta
- Senior Research Assistant, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Ritam Chowdhury
- Research Associate, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - R Sterling Haring
- Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Leah I Leinbach
- Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - John Petrone
- Program Director of Dental Residency, Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Martin J Spitzer
- Associate Professor, Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Bonn, Bonn, Germany
| | - Eric B Schneider
- Director of Quantitative Science, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Johns Hopkins School of Medicine, Baltimore, MD.
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Effect of Osteoporosis on Bone Density of Orthognathic Osteotomy Sites in Maxillofacial Region. J Craniofac Surg 2016; 27:e678-e683. [DOI: 10.1097/scs.0000000000003064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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Verweij JP, Houppermans PN, Gooris P, Mensink G, van Merkesteyn JR. Risk factors for common complications associated with bilateral sagittal split osteotomy: A literature review and meta-analysis. J Craniomaxillofac Surg 2016; 44:1170-80. [DOI: 10.1016/j.jcms.2016.04.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/11/2016] [Accepted: 04/14/2016] [Indexed: 11/16/2022] Open
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Verweij J, Mensink G, Fiocco M, van Merkesteyn J. Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients. Int J Oral Maxillofac Surg 2016; 45:898-903. [DOI: 10.1016/j.ijom.2016.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 11/15/2022]
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Evaluation of Mandibular Anatomy Associated With Bad Splits in Sagittal Split Ramus Osteotomy of Mandible. J Craniofac Surg 2016; 27:e500-4. [DOI: 10.1097/scs.0000000000002798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tseng WC, Chen YW, Cheng CD, Cherng CH. Airway protection using a modified nasopharyngeal tube after orthognathic surgery. J Clin Anesth 2016; 31:189-90. [DOI: 10.1016/j.jclinane.2016.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022]
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Does Simultaneous Third Molar Extraction Increase Intraoperative and Perioperative Complications in Orthognathic Surgery? J Craniofac Surg 2016; 27:923-6. [DOI: 10.1097/scs.0000000000002648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bowe D, Gruber E, McLeod N. Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries. Br J Oral Maxillofac Surg 2016; 54:362-5. [DOI: 10.1016/j.bjoms.2016.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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[National survey: Avulsion of included wisdom teeth in mandibular orthognathic surgery]. ACTA ACUST UNITED AC 2016; 117:131-5. [PMID: 26975940 DOI: 10.1016/j.revsto.2016.02.002] [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: 10/07/2015] [Revised: 11/30/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There is no recommendation concerning wisdom teeth (WT) extraction in mandibular orthognathic surgery. We carried out an investigation among the members of the French Society of Stomatology and Oro-maxillofacial Surgery (SFSCMFCO), in order to evaluate the practices and habits of maxillofacial surgeons in this field. MATERIALS AND METHODS We emailed the 424 members of the SFSCMFCO with a questionnaire. RESULTS We obtained 143 feedbacks that could be exploited. In total, 72.5% of practitioners prefer WT to be extracted before performing a bilateral sagittal spilt osteotomy (BSSO). In this case, a period of 6 months between the two surgeries was considered as desirable by more than 70% of the surgeons. In total, 74.6% of the surgeons thought that the presence of WT could make a BSSO more complicated. However, 73.9% of the surgeons would not postpone the BBSO in a patient ready for surgery but with remaining impacted WT. DISCUSSION A majority of surgeons think that the presence of impacted WT may complicate a BSSO and increases the risk of bad split. Most of the authors recommend extracting the impacted WT 6 months before BSSO at least. However, these potential complications are easy to overcome and don't compromise the final result. Therefore, we think that impacted WT should not delay a BSSO if the orthodontic preparation makes the patient ready for surgery.
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Steenen SA, van Wijk AJ, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg 2016; 45:971-9. [PMID: 26980136 DOI: 10.1016/j.ijom.2016.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 11/26/2022]
Abstract
An unfavourable and unanticipated pattern of the bilateral sagittal split osteotomy (BSSO) is generally referred to as a 'bad split'. Patient factors predictive of a bad split reported in the literature are controversial. Suggested risk factors are reviewed in this article. A systematic review was undertaken, yielding a total of 30 studies published between 1971 and 2015 reporting the incidence of bad split and patient age, and/or surgical technique employed, and/or the presence of third molars. These included 22 retrospective cohort studies, six prospective cohort studies, one matched-pair analysis, and one case series. Spearman's rank correlation showed a statistically significant but weak correlation between increasing average age and increasing occurrence of bad splits in 18 studies (ρ=0.229; P<0.01). No comparative studies were found that assessed the incidence of bad split among the different splitting techniques. A meta-analysis pooling the effect sizes of seven cohort studies showed no significant difference in the incidence of bad split between cohorts of patients with third molars present and concomitantly removed during surgery, and patients in whom third molars were removed at least 6 months preoperatively (odds ratio 1.16, 95% confidence interval 0.73-1.85, Z=0.64, P=0.52). In summary, there is no robust evidence to date to show that any risk factor influences the incidence of bad split.
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Affiliation(s)
- S A Steenen
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands.
| | - A J van Wijk
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry (ACTA) in Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Spaarne Gasthuis Haarlem, Academic Medical Centre (AMC), Amsterdam, and Academic Centre for Dentistry (ACTA) in Amsterdam, The Netherlands
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Steenen SA, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. Int J Oral Maxillofac Surg 2016; 45:887-97. [PMID: 26936377 DOI: 10.1016/j.ijom.2016.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/03/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022]
Abstract
An unfavourable and unanticipated pattern of the mandibular sagittal split osteotomy is generally referred to as a 'bad split'. Few restorative techniques to manage the situation have been described. In this article, a classification of reported bad split pattern types is proposed and appropriate salvage procedures to manage the different types of undesired fracture are presented. A systematic review was undertaken, yielding a total of 33 studies published between 1971 and 2015. These reported a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies in 10,271 patients. The total reported incidence of bad split was 2.3% of sagittal splits. The most frequently encountered were buccal plate fractures of the proximal segment (types 1A-F) and lingual fractures of the distal segment (types 2A and 2B). Coronoid fractures (type 3) and condylar neck fractures (type 4) have seldom been reported. The various types of bad split may require different salvage approaches.
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Affiliation(s)
- S A Steenen
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), Amsterdam, Netherlands.
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Spaarne Gasthuis Haarlem, Academic Medical Centre (AMC), Amsterdam, and Academic Centre for Dentistry (ACTA) in Amsterdam, Netherlands
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Abstract
Bilateral sagittal split osteotomy has become the standard mandibular surgery for the treatment of dento-facial deformities. Even patients with less important deformities may undergo surgery. The morbidity must be as low as possible. We describe a technique with reduced split surfaces. The osseous section follows an oblique line since the thorn of Spix below and outside towards the supra-angular region. This section is completed by an osteotomy of the posterior border of the mandible. This split never reaches the inferior alveolar nerf tunnel. The protection of the alveolar nerve is increased what decreases considerably the risk of nervous complications of this intervention. The majority of the mandibular movements are possible by this technique with the exception of the important advancements and the increase of the height of the ramus.
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Affiliation(s)
| | - Wolfgang Kater
- Zeppelinstraße 24, D-61352 Bad Homburg vor der Höhe, Allemagne
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Access to the Mandibular Angle Using a Sagittal Split to Address Pathologic Displacement of a Mandibular Third Molar. J Oral Maxillofac Surg 2015; 73:2285.e1-5. [PMID: 26408844 DOI: 10.1016/j.joms.2015.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
Access to the mandibular angle for removal of pathology poses a unique challenge to surgeons. Intraoral approaches result in considerable bone removal and potential damage to the inferior alveolar nerve (IAN). Extraoral approaches are associated with a cutaneous scar and the potential for facial nerve damage. This report describes the case of a 53-year-old man with a deeply impacted third molar associated with a cystic lesion that was treated by enucleation using an intraoral sagittal split osteotomy. This approach allowed for complete access and visualization of the cyst and displaced third molar and protection of the IAN with minimal surgical morbidity.
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