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Shah S, Block-Wheeler N, Liu K, Weintraub MR, Williams WB. The Association of Body Mass Index and Early Outcomes Following Orthognathic Surgery. J Oral Maxillofac Surg 2024; 82:782-791. [PMID: 38643964 DOI: 10.1016/j.joms.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited. PURPOSE The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery. STUDY DESIGN, SETTING, AND SAMPLE This is a retrospective cohort study of patients (n = 118) aged > 14 years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded. PREDICTOR VARIABLE The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese). MAIN OUTCOME VARIABLE(S) The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time. COVARIATES The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification. ANALYSES Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P < .05. RESULTS The study sample was composed of 118 subjects with a mean age of 26.91 years (standard deviation 9.43). Forty-seven percent (n = 55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P = .02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio = 1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio = 1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification. CONCLUSION AND RELEVANCE Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.
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Affiliation(s)
- Swapnil Shah
- Medical Student, Creighton University School of Medicine, Omaha, NE; Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA.
| | - Nikolas Block-Wheeler
- Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA
| | - Kalena Liu
- Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA; Medical Student, City University of New York School of Medicine, New York, NY
| | - Miranda Ritterman Weintraub
- Research Manager, Department of Graduate Medical Education, Kaiser Permanente, Northern California, Oakland, CA
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Ebker M, Goedecke M, Wollersheim T, Heiland M, Ebker T. Maxillomandibular advancement is a safe procedure in patients with obstructive sleep apnoea. Results of a retrospective study. Br J Oral Maxillofac Surg 2023; 61:491-496. [PMID: 37517940 DOI: 10.1016/j.bjoms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Obstructive sleep apnoea (OSA) is a syndrome with a high burden on public health. Maxillomandibular advancement (MMA) has proven to be a highly effective treatment option. This retrospective analysis evaluated the safety of maxillomandibular advancement with rotation in patients with OSA. A total of 63 patients with OSA were included in this study. Surgical treatment by maxillomandibular advancement was virtually planned based on preoperative cone beam computed tomography (CBCT). A 3D printed guide and a customised implant were used for surgical transfer. The safety of MMA was evaluated based on the necessity of postoperative intermediate care unit (IMCU) stay, duration of stay in hospital, and recording of medical complications. A total of 63.5% of the OSA patients treated by MMA (n = 40/63) were postoperatively transferred from the recovery room directly to the regular ward, while 36.5% of the patients (n = 23/63) stayed on IMCU for at least one night. On average, the length of hospitalisation was four days after surgery. One patient from the ward group and one patient from the IMCU group developed a major complication according to Clavian-Dindo classification grade IV. MMA is a safe surgical procedure. The necessity for postoperative monitoring in an IMCU setting should be based on an individual risk evaluation. However, since major complications can occur, MMA should be performed as an inpatient procedure in a hospital with available intensive medicine care. This study underlines the safety of MMA in OSA patients.
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Affiliation(s)
- Maria Ebker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Maximilian Goedecke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Tobias Wollersheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Tobias Ebker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universit ät zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
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Ho JPTF, Zhou N, de Lange J. Obstructive Sleep Apnea Resolution in Hypopnea-Predominant versus Apnea-Predominant Patients after Maxillomandibular Advancement. J Clin Med 2022; 12:jcm12010311. [PMID: 36615111 PMCID: PMC9820928 DOI: 10.3390/jcm12010311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
This retrospective cohort study aimed: (1) to analyze the influence of apnea-predominant versus hypopnea-predominant obstructive sleep apnea (OSA) on surgical outcome after maxillomandibular advancement (MMA); and (2) to evaluate whether MMA alters the presence of apnea-predominant to hypopnea-predominant OSA more than vice versa. In total 96 consecutive moderate to severe OSA patients, who underwent MMA between 2010 and 2021, were included. The baseline apnea−hypopnea index, apnea index, and oxygen desaturation index were significantly higher in apnea-predominant group, while the hypopnea index was significantly higher in hypopnea-predominant group (p < 0.001). No significant difference was found between apnea-predominant group and hypopnea-predominant group in the degree of advancement of A-point, B-point, and pogonion. Surgical success and cure were significantly higher in the hypopnea-predominant group compared to the apnea-predominant group, 57.4% versus 82.1% (p = 0.021) and 13.2% versus 55.5% (p = 0.012), respectively. Of the 68 (70.8%) apnea-predominant patients, 37 (54.4%) shifted to hypopnea-predominant after MMA. Of the 28 (29.2%) hypopnea-predominant patients, 7 (25%) shifted to apnea-predominant postoperatively. These findings suggest that preoperative hypopnea-predominant OSA patients might be more suitable candidates for MMA compared to preoperative apnea-predominant OSA patients. Additionally, MMA proved to alter the presence of apnea-predominant to hypopnea-predominant OSA to a larger extend than vice versa.
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Affiliation(s)
- Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, 1815 JD Alkmaar, The Netherlands
- Correspondence:
| | - Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
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Bendersky J, Uribe M, Bravo M, Vargas JP, Flores E, Aguero I, Villanueva J, Urrutia G, Bonfill X. Systematic mapping review of orthognathic surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e285-e305. [PMID: 35568120 DOI: 10.1016/j.jormas.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
STUDY DESIGN Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.
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Affiliation(s)
- Josefina Bendersky
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Macarena Uribe
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Maximiliano Bravo
- Oral and Maxillofacial Surgery Program, Universidad de los Andes, Santiago, Chile.
| | - Juan Pablo Vargas
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Enrique Flores
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Ignacio Aguero
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery and Cochrane Associated Center at Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile.; Servicio de Cirugía Maxilofacial. Hospital Clínico San Borja-Arriarán. Sta. Rosa 1234, Santiago, Región Metropolitana, Chile.
| | - Gerard Urrutia
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Xavier Bonfill
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
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Schwer CI, Roth T, Gass M, Rothweiler R, Loop T, Metzger MC, Kalbhenn J. Risk Factors for Prolonged Mechanical Ventilation and Delayed Extubation Following Bimaxillary Orthognathic Surgery: A Single-Center Retrospective Cohort Study. J Clin Med 2022; 11:jcm11133829. [PMID: 35807112 PMCID: PMC9267492 DOI: 10.3390/jcm11133829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Bimaxillary orthognathic surgery bears the risk of severe postoperative airway complications. There are no clear recommendations for immediate postoperative follow-up and monitoring. Objective: to identify potential risk factors for prolonged mechanical ventilation and delayed extubation in patients undergoing bimaxillary orthognathic surgery. Methods: The data of all consecutive patients undergoing bimaxillary surgery between May 2012 and October 2019 were analyzed in a single-center retrospective cohort study. The clinical data were evaluated regarding baseline characteristics and potential factors linked with delayed extubation. Results: A total of 195 patients were included; 54.9% were female, and the median age was 23 years (IQR 5). The median body mass index was 23.1 (IQR 8). Nine patients (4.6%) were of American Society of Anesthesiologists Physical Status Classification System III or higher. The median duration of mechanical ventilation in the intensive care unit was 280 min (IQR, 526 min). Multivariable analysis revealed that premedication with benzodiazepines (odds ratio (OR) 2.60, 95% confidence interval (0.99; 6.81)), the male sex (OR 2.43, 95% confidence interval (1.10; 5.36)), and the duration of surgery (OR 1.54, 95% confidence interval (1.07; 2.23)) were associated with prolonged mechanical ventilation. By contrast, total intravenous anesthesia was associated with shorter ventilation time (OR 0.19, 95% confidence interval (0.09; 0.43)). Conclusion: premedication with benzodiazepines, the male sex, and the duration of surgery might be considered to be independent risk factors for delayed extubation in patients undergoing bimaxillary surgery.
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Affiliation(s)
- Christian I. Schwer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.L.); (J.K.)
- Correspondence: ; Tel.: +49-761-270-23060
| | - Teresa Roth
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.R.); (M.G.); (R.R.); (M.C.M.)
| | - Mathieu Gass
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.R.); (M.G.); (R.R.); (M.C.M.)
| | - René Rothweiler
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.R.); (M.G.); (R.R.); (M.C.M.)
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.L.); (J.K.)
| | - Marc C. Metzger
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.R.); (M.G.); (R.R.); (M.C.M.)
| | - Johannes Kalbhenn
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany; (T.L.); (J.K.)
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Ho JPTF, Zhou N, Verbraecken J, Vries ND, Lange JD. Central and mixed sleep apnea related to patients treated with maxillomandibular advancement for obstructive sleep apnea: A retrospective cohort study. J Craniomaxillofac Surg 2022; 50:537-542. [PMID: 35778235 DOI: 10.1016/j.jcms.2022.06.005] [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: 08/06/2021] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the clinical efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) patients with a percentage of central and mixed apnea index in the total apnea-hypopnea index (CMAI%) ≧25%. Patients treated with MMA for OSA were retrospectively evaluated for baseline and postoperative patient data and polysomnographic results. The pre- and postoperative obstructive, central and mixed apnea parameters were compared. Of the included 78 patients, 21 patients (27%) presented with CMAI% ≧25% (median CMAI%, 49.1%; 35.9-63.8) prior to MMA. In 67% of these cases, MMA resulted in CMAI% <25 (median CMAI%, 6.1%; 2.1-8.9) and significantly improved the apnea-hypopnea index (AHI) (p < 0.001), the lowest oxyhemoglobin saturation (p < 0.001), central and mixed apnea index (p < 0.001), percentage of central and mixed apneas of total AHI (p = 0.004), central apnea index (p < 0.001), and mixed apnea index (p < 0.001). CMAI% ≧25% emerged in 25% of patients after MMA (median CMAI%, 49.1%; 35.9-63.8). Within the undeniable limitations of the study, it seems that the presence of CMAI% ≧25% should not be regarded as a contraindication for MMA in OSA patients.
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Affiliation(s)
- Jean-Pierre T F Ho
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.
| | - Ning Zhou
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands.
| | - Jan de Lange
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Lee CC, Wang TT, Caruso DP, Williams R, Peacock ZS. Orthognathic Surgery in Older Patients: Is Age Associated with Perioperative Complications? J Oral Maxillofac Surg 2022; 80:996-1006. [DOI: 10.1016/j.joms.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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Airway Management Failure after Delayed Extubation in a Patient with Oral Malignant Melanoma Who Underwent Partial Mandibulectomy and Reconstruction with a Free Flap. Case Rep Dent 2022; 2021:7792843. [PMID: 34976416 PMCID: PMC8716215 DOI: 10.1155/2021/7792843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022] Open
Abstract
Maxillofacial surgery may cause severe complications in perioperative airway management. We report a case of failed airway management in a patient who underwent segmental mandibulectomy, radical neck dissection, and reconstruction with a free flap. The patient was extubated approximately 36 hours after surgery. Approximately 7 hours after extubation, the patient complained of dyspnoea, and respiratory failure followed. Bag-mask ventilation, direct laryngoscopy, video laryngoscopy, and supraglottic airway access were ineffective. The surgical airway was secured with an emergency tracheostomy while performing cardiopulmonary resuscitation. However, the patient experienced permanent hypoxic brain damage. The airway of patients with oral cancer may be compromised postoperatively due to surgical trauma and bulky flap reconstruction. Patients should be closely monitored during the postoperative period to prevent airway failure. Early diagnosis and airway management before airway failure occurs are important. Medical staff should be aware of airway management algorithms, be trained to perform difficult airway management, and have the required equipment readily available.
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Guissé NF, Stone JD, Keil LG, Bastrom TP, Erickson MA, Yaszay B, Cahill PJ, Parent S, Gabos PG, Newton PO, Glotzbecker MP, Kelly MP, Pahys JM, Fletcher ND. Modified Clavien-Dindo-sink classification system for adolescent idiopathic scoliosis. Spine Deform 2022; 10:87-95. [PMID: 34351605 DOI: 10.1007/s43390-021-00394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The Clavien-Dindosink (CDS) classification system provides more treatment-focused granularity than subjective methods of describing surgical complications; however, it has not been validated in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The purpose of this study was to modify the CDS system for application in patients with AIS undergoing PSF to assess its inter- and intra-rater reliability for describing complications faced by this population. METHODS A review of all complications specific to patients with AIS captured in a large multicenter international database was performed. All complications were classified according to CDS, modified by addition of "prolonged initial hospital stay" as a criterion for Grade II. A survey of this complication list and an additional 20 clinical vignettes (sent out on two occasions) was sent to nine spinal deformity surgeons. Weighted kappa values were used to determine inter- and intra-rater reliability. RESULTS The Fleiss κ value for interrater reliability among 5 respondents grading all AIS complications was 0.8 (very good). For each grade, interrater reliability was very good, with an overall range of 0.8-1. The overall kappa value for intrarater reliability among eight respondents grading 20 vignettes was between 0.6 (good) and 0.9 (very good). CONCLUSION The modified CDS classification system has very good interrater and intrarater reliability in describing complications following PSF in patients with AIS. This system may be of greater utility for reporting outcomes than a "major" versus "minor" complication system and can serve as a valuable tool for improving surgical practices and patient outcomes in this population. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Ndéye F Guissé
- Department of Orthopaedics, Washington University, St. Louis, MO, USA
| | - Joseph D Stone
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Lukas G Keil
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Tracey P Bastrom
- Department of Orthopaedic Surgery, Children' Healthcare of Atlanta, 1400 Tullie Road, Atlanta, GA, 30329, USA
| | - Mark A Erickson
- Department of Orthopaedic Surgery, University of Colorado, Boulder, CO, USA
| | - Burt Yaszay
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan Parent
- Department of Orthopaedic Surgery, University of Montreal, Montreal, Canada
| | - Peter G Gabos
- Department of Orthopaedic Surgery, Afred I. DuPont Institute, Wilmington, DE, USA
| | - Peter O Newton
- Department of Orthopedics Surgery, UC San Diego School of Medicine, San Diego, CA, USA
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, University Hospitals Rainbow Babies Hospital, Cleveland, OH, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Joshua M Pahys
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Nicholas D Fletcher
- Department of Orthopaedic Surgery, Children' Healthcare of Atlanta, 1400 Tullie Road, Atlanta, GA, 30329, USA.
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Damrongsirirat N, Kaboosaya B, Siriwatana K, Subbalekha K, Jansisyanont P, Pimkhaokham A. Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center. J Craniomaxillofac Surg 2021; 50:197-203. [PMID: 34876326 DOI: 10.1016/j.jcms.2021.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022] Open
Abstract
This article aimed to review adverse events and complications to orthognathic surgery based upon 10 years. This study was a retrospective investigation between 2009 and 2018. Independent variables such as sex, age, pre-operative conditions, diagnosis, type of surgery, bleeding volume, surgery duration, and hospitalization were recorded. The data regarding orthognathic surgery adverse events and complications were evaluated and statistically analyzed with a significance level of p < 0.05. A total of 891 patients were included in this study (male 39.1%, female 60.9%) with a mean age of 26.4 ± 6.09 years. A neurosensory disturbance was found as immediate post-operative sequelae as 93.5%. The four most frequent complications had a relapse (6.4%), post-operative TMD (5.7%), unfavorable osteotomy (5.5%), and infection (4.9%), which seem to be more common in males. An average blood loss was 497 ± 371 ml and the average operative time was 401 ± 109.3 min. Complication rates were statistically affected by bleeding volume (p-value = 0.01), operative time (p-value = 0.03), and type of skeletal deformity (p-value = 0.01). Although numerous complications were recorded, no fatal complications were experienced. Bleeding time, operative time, and skeletal classification have significant influence on orthognathic surgery complications. However, a multitude of factors could be modified to reduce the complication rate and improve the result of the treatment. One of the most significant factors was the operative time.
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Affiliation(s)
- Napat Damrongsirirat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
| | - Kiti Siriwatana
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Pornchai Jansisyanont
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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11
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Is Intensive Care Unit Monitoring Necessary After Maxillomandibular Advancement for Management of Obstructive Sleep Apnea? J Oral Maxillofac Surg 2021; 80:456-464. [PMID: 34871584 DOI: 10.1016/j.joms.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/23/2021] [Accepted: 11/09/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Maxillomandibular advancement (MMA) is an accepted treatment modality for obstructive sleep apnea. The purpose of this study was to evaluate the incidence of complications requiring an intensive care unit (ICU) level of care and the necessity of routine overnight ICU airway monitoring after MMA. PATIENTS AND METHODS This was a retrospective cohort study of patients undergoing MMA at Massachusetts General Hospital from 2003 to 2020. The primary predictor variable was postoperative admission to the ICU versus post anesthesia care unit (PACU) or ward. The primary outcome variable was grade IV or V complications as scored using the Clavien-Dindo classification system. The secondary outcome variables included postoperative SpO2 nadir and length of hospital stay. Descriptive and bivariate statistics were computed to measure the association between complications and predictor variables. RESULTS The study sample consisted of 104 patients (74.0% male, mean age 37.6 ± 12.1 years), 61 of whom were admitted to the ICU (58.7%). During the initial 24 hours of airway monitoring, the mean SpO2 nadir was 93.7 ± 2.59% for patients admitted to the ICU compared with 94.0 ± 6.56% for patients admitted to the PACU or ward (P = .862). Patients experienced 2 grade IV complications (1.92%) and no grade V complications, with no statistical association between complications and postoperative admission location (P = 1.000). Age (P = .002) and operative time (P = .046) were the only variables statistically associated with grade IV or V complications. There was no difference in length of hospital stay between patients admitted to the ICU (2.64 ± 1.37 days) versus PACU or ward (2.58 ± 1.62 days). CONCLUSIONS The incidence of complications requiring ICU-level care after MMA for obstructive sleep apnea is low. Additional studies are warranted to guide development of feasible, cost-effective perioperative protocols for patients undergoing MMA.
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