Benign paroxysmal positional vertigo as a complication of orthognathic surgery

Assessment of Benign Paroxysmal Positional Vertigo (BPPV) Incidence Following Closed Sinus Lift and Ridge Splitting Surgeries: A Cohort Study

Background

With a notable increase in demand for implant placement in atrophic cases, this study aimed to evaluate the occurrence of benign paroxysmal positional vertigo (BPPV) following closed sinus lift and ridge splitting surgeries.

Materials and Methods

Healthy patients requiring posterior maxillary closed sinus lift or ridge split surgeries at Mashhad Dental School from September 2021 to September 2022 were enrolled in this cohort study. A single surgeon performed all surgeries under standard protocols. The intervention groups consisted of closed sinus lift and ridge splitting procedures. The primary outcome variable was BPPV, and the Dix-Hallpike maneuver was used before and after the operation to diagnose BPPV. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05.

Results

A total of 112 patients (51 women and 61 men) with a mean age of 48.4 ± 9.5 years participated in the study. The average BMI was 21.5 ± 2.4, and the mean duration of surgery was 31.9 ± 6.6 min. Of the patients, 10.7, 36.6, 27.7, 12.5, and 1.8% presented with hypertension, headache, dizziness, nausea, and BPPV, respectively. Two patients (3.1%) in the closed sinus lift group were diagnosed with BPPV, whereas no patients in the ridge split group were diagnosed. However, there was no significant difference (P = 0.509). No statistically significant difference in the occurrence of certain symptoms between two groups was found. There was a significant association between certain health conditions and the onset of BPPV.

Conclusion

The study suggests closed sinus lift surgery may have a higher risk of BPPV than ridge split surgery, but further studies with larger sample are needed to confirm this association.

Acute Benign Paroxysmal Positional Vertigo After Endothelial Keratoplasty-A Unique Cause of Postoperative Nausea and Headache

PURPOSE

To describe a case of new-onset benign paroxysmal positional vertigo (BPPV) after uncomplicated Descemet stripping automated endothelial keratoplasty.

METHODS

Case report and review of literature.

RESULTS

A 61-year-old woman with a history of steroid-induced glaucoma and penetrating keratoplasty for Fuchs endothelial dystrophy, and no history of BPPV or other vertigo, underwent Descemet stripping automated endothelial keratoplasty for penetrating keratoplasty graft failure. On the third postoperative day, she developed acute spinning vertigo, nausea, and headache on sitting up after 3 days of strict supine positioning. Her ophthalmic examination was benign, with no evidence of a pupillary block, and she was diagnosed by an otologist with BPPV. Her symptoms resolved after 1 week without further intervention.

CONCLUSIONS

BPPV is a benign but rare complication of nonotologic surgery and has not been previously reported with ophthalmic surgery. The overlap in symptomatology between BPPV and other serious and potentially vision-threatening causes of postoperative nausea and headache, such as pupillary block glaucoma, makes this a relevant etiology to consider in the spectrum of postendothelial keratoplasty complications.

Potential Risk of Benign Paroxysmal Positional Vertigo Due To Traumatic Effect of Osteotomy in Septorhinoplasty Patients

PURPOSE

We investigated the effect of osteotomy on the vestibular system in septorhinoplasty patients and determined the potential risk of benign paroxysmal positional vertigo (BPPV) in these patients.

PATIENTS AND METHODS

In the present prospective study, 47 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, 1-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test, and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week.

RESULTS

No significant differences were found between the 2 groups in terms of the static balance tests, dynamic balance tests, positional balance tests, or head impulse test results. The postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty group but none in the control group.

CONCLUSIONS

BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike and supine roll tests. To avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be given to the applied force, and sharp osteotomes should be used.

Benign Paroxysmal Positional Vertigo After Oral and Maxillofacial Surgery: Our Experience and Review of Literature

Objectives

The aim of our study is to evaluate the influence of patient risk factors and the length of surgical time on the onset of BPPV (benign paroxysmal positional vertigo) and suggest surgical and clinical strategies to prevent this rare complication.

Method

Our retrospective study analyzes that, in 2 years, 281 patients, divided into three groups, underwent wisdom teeth extraction, sinus lift elevation and orthognathic surgery, at the Oral and Maxillofacial Department of the University of Naples "Federico II."

Results

Twenty-one patients presented postoperative BPPV. Some comorbidities, like dyslipidemia, high cholesterol levels, vascular problems, endocrinological disorders, perimenopausal age, female gender, cranial trauma, neurologic disorders, migraine, hypovitaminosis D, autoimmune disease, flogosis of inner ear, can be risk factors to the occurrence of postoperative vertigo.

Conclusion

Our statistical analysis revealed a relationship between surgical time and comorbidity and onset of vertigo for each group of patients.

Complications associated with orthognathic surgery

While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic surgery lies on the aesthetic side or the functional side. There is a wide variety of complications associated with orthognathic surgery. There should be a clear distinction between malpractice and complications. Complications can be resolved without any serious problems if the cause is detected early and adequate treatment provided. Oral and maxillofacial surgeons must have a full understanding of the types, causes, and treatment of complications, and should deliver this information to patients who develop these complications.

Biomechanical comparison of a novel engine-driven ridge spreader and conventional ridge splitting techniques

OBJECTIVES

Ridge splitting techniques are used for horizontal ridge augmentation in implant dentistry. Recently, a novel engine-driven ridge splitting technique was introduced. This study compared the mechanical forces produced by conventional and engine-driven ridge splitting techniques in porcine mandibles.

MATERIAL AND METHODS

In 33 pigs, mandibular premolar areas were selected for the ridge splitting procedures, designed as a randomized split-mouth study. The conventional group underwent a chisel-and-mallet procedure (control group, n = 20), and percussive impulse (Newton second, Ns) was measured using a sensor attached to the mallet. In the engine-driven ridge spreader group (test group, n = 23), a load cell was used to measure torque values (Newton centimeter, Ncm). Horizontal acceleration generated during procedures (control group, n = 10 and test group, n = 10) was compared between the groups.

RESULTS

After ridge splitting, the alveolar crest width was significantly increased both in the control (1.23 ± 0.45 mm) and test (0.98 ± 0.41 mm) groups with no significant differences between the groups. The average impulse of the control group was 4.74 ± 1.05 Ns. Torque generated by rotation in the test group was 9.07 ± 2.15 Ncm. Horizontal acceleration was significantly less in the test group (0.82 ± 1.05 g) than the control group (64.07 ± 42.62 g) (P < 0.001).

CONCLUSIONS

Narrow edentulous ridges can be expanded by novel engine-driven ridge spreaders. Within the limits of this study, the results suggested that an engine-driven ridge splitting technique may be less traumatic and less invasive than a conventional ridge splitting technique.

Preoperative, intraoperative, and postoperative complications in orthognathic surgery: a systematic review

Objectives

The aim of this study was to determine whether orthognathic surgery is associated with any complications, and what type of complications may occur.

Materials and methods

Data were obtained using PubMed (MEDLINE), ISI Web of Knowledge, Ovid, Cochrane Library, Embase Library, and an additional manual search. The titles and abstracts of the electronic search results were screened and evaluated by two observers for eligibility according to the inclusion and exclusion criteria.

Results

A total of 1924 articles were identified, and we retained 44 articles for the final analysis. The Prisma diagram flowchart demonstrates our selection scheme. For the purpose of this study, the Cochrane data extraction form was modified. One review author extracted data from the included studies, and the second author checked all of the forms. The hierarchy of evidence classification from the UK NHS Centre for Reviews and Dissemination was used to assess the level of evidence for the retrieved studies.

Conclusions

An evaluation of the obtained studies revealed the existence of a large number of varied complications associated with orthognathic surgery procedures.

Clinical relevance

Oral and maxillofacial surgeons, orthodontists, and the surgical team need to prevent such complications during preoperative, intraoperative, and postoperative periods to increase the safety of orthognathic surgery procedures. This review was registered on http://www.crd.york.ac.uk/PROSPERO as CRD42013004711.

Electronic supplementary material

The online version of this article (doi:10.1007/s00784-015-1452-1) contains supplementary material, which is available to authorized users.

Benign paroxysmal positional vertigo during lateral window sinus lift procedure: a case report and review

PURPOSE

Benign paroxysmal positional vertigo (BPPV) is a possible and well-documented complication after the osteotome internal sinus lift technique. But we report a case of unexpected BPPV complication after direct sinus lift by lateral approach for implant placement that was not reported till date.

METHODS

A 30-year-old woman had undergone direct sinus lift procedure by lateral window technique to replace her missing right molar with dental implant. The patient suffered with intense vertigo with nausea, vomiting, and aggravated when she changed the position of her head towards right immediately after procedure and was diagnosed with BPPV after the referral.

CONCLUSION

We assume that prolonged hyperextended head position of iatrogenic origin can be the reason, in this case, for BPPV after direct lateral sinus lift procedure. There is also a possibility that the temporal relationship with the surgical area and surgical action by rotating tools during window preparation are also contributing factors.

Benign Paroxysmal Positional Vertigo: An Integrated Perspective

Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.