1
|
Krishnanunni K, Parameswaran A, Tangutur SP. Evaluation of nasolacrimal canal morphology in different facial skeletal relationships. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101722. [PMID: 38042348 DOI: 10.1016/j.jormas.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Abnormal morphological variations of nasolacrimal canal (NLC) and its lack of understanding contributes to acquired injuries during craniomaxillofacial surgical procedures which leads untoward postoperative complications like nasolacrimal obstruction (NLO) and epiphora. PURPOSE The purpose of this study was to determine dimensional and volumetric morphological variations of nasolacrimal canal in various facial skeletal relationships which aid in performing a precise and safe surgery. MATERIALS AND METHODS This retrospective cohort study involved dimensional and volumetric analysis of nasolacrimal canal procured from computed tomography scans of 47 individuals grouped as ClassI, Class II and Class III, and unilateral cleft lip and palate (UCLP) groups. The outcome variables included length of NLC, volume of NLC, distance between the inferior orifice of the NLC to nasal floor, distance between inferior orifice of NLC to canine apex and distance between inferior orifice of NLC to central incisor apex. The objectives were to analyse morphological variation of NLC in different facial skeletal relationships and to evaluate the variation with change in facial sides and its relationship with surrounding structures. RESULTS Volume of the NLC was found significant in Class I and UCLP population (p < 0.05) with the greatest volume in the UCLP group. The mean linear and volumetric measurements between the right and left sides were found insignificant among all groups. Inferior orifice of NLC from canine apex were farthest in Class III and nearest in the UCLP group (p < 0.05). There was no significant association between outcome variables and skeletal base configuration. CONCLUSION NLC demonstrates dimensional and anthropometric variations between different skeletal relationships and this study is inevitable in understanding the probability of NLC injury during maxillofacial surgeries.
Collapse
Affiliation(s)
- Keerthi Krishnanunni
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India
| | - Anantanarayanan Parameswaran
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India.
| | - Srinivasa Prasad Tangutur
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India
| |
Collapse
|
2
|
Loureiro RM, Collin J, Sumi DV, Araújo LC, Murakoshi RW, Gomes RLE, Daniel MM. Postoperative CT findings of orthognathic surgery and its complications: A guide for radiologists. J Neuroradiol 2021; 49:17-32. [PMID: 33864896 DOI: 10.1016/j.neurad.2021.04.033] [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] [Received: 12/20/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.
Collapse
Affiliation(s)
- Rafael Maffei Loureiro
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - John Collin
- Bristol Royal Infirmary, Department of Oral and Maxillofacial Surgery, Marlborough Street, Bristol BS2 8HW, United Kingdom.
| | - Daniel Vaccaro Sumi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Luziany Carvalho Araújo
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Rodrigo Watanabe Murakoshi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Regina Lucia Elia Gomes
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Mauro Miguel Daniel
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| |
Collapse
|
3
|
Thiem DGE, Schneider D, Hammel M, Saka B, Frerich B, Al-Nawas B, Kämmerer PW. Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis. Clin Oral Investig 2020; 25:3315-3327. [PMID: 33155066 PMCID: PMC8060167 DOI: 10.1007/s00784-020-03664-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/28/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. MATERIALS AND METHODS In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0-4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. RESULTS Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients' self-perception (85.4%), with 60.4% of patients opting for surgery again. CONCLUSIONS Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. CLINICAL RELEVANCE Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.
Collapse
Affiliation(s)
- Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany. .,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | | | - Bassam Saka
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany.,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| |
Collapse
|
4
|
Ferri J, Druelle C, Schlund M, Bricout N, Nicot R. Complications in orthognathic surgery: A retrospective study of 5025 cases. Int Orthod 2019; 17:789-798. [DOI: 10.1016/j.ortho.2019.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Han G, Song C, Lin S, Piao Z. A Rare Case of Nasolacrimal Duct Partial Obstruction After Extraction of an Impacted Maxillary Canine. J Oral Maxillofac Surg 2019; 78:350-356. [PMID: 31785248 DOI: 10.1016/j.joms.2019.10.020] [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: 08/04/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
The main complications of tooth extraction include jaw fracture, maxillary sinus damage, adjacent teeth damage, nerve damage, root fracture, infection, bleeding, and swelling. Despite the theoretical possibility that tooth extraction could result in nasolacrimal duct obstruction, to the best of our knowledge, no cases have yet been reported. In the present study, we describe a case in which the nasolacrimal duct was partially obstructed after extraction of an impacted maxillary canine, causing paranasal discomfort and lower eyelid swelling.
Collapse
Affiliation(s)
- Guoxu Han
- Resident, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ci Song
- Resident, Department of Stomatology, Nanfang Hospital, Southern Medical University; and Instructor, Department of Stomatology, College of Stomatology, Southern Medical University, Guangzhou, China
| | - Shaoqin Lin
- Nurse, Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhengguo Piao
- Department Head, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
6
|
Bang SR, Lee TE, You IC, Cho NC, Ahn M. Loss of Reflex Tearing after Maxillary Orthognathic Surgery Case Report and Literature Review. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1295] [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]
Affiliation(s)
- So Ra Bang
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - Tae Eun Lee
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
7
|
Ophthalmologic Complications Associated With Oculofacial Plastic and Esthetic Surgeries. J Craniofac Surg 2018; 29:1208-1211. [DOI: 10.1097/scs.0000000000004515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
8
|
Ozcan E, Dergin G, Basa S. Prevalence of nasolacrimal canal obstruction and epiphora following maxillary orthognathic surgery. Int J Oral Maxillofac Surg 2018; 47:715-720. [DOI: 10.1016/j.ijom.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 11/17/2022]
|
9
|
Ozdemir YB, Dolanmaz D, Esen A, Terzioglu H, Saglam H. Evaluation of strain values of critical anatomic regions for two different pterygomaxillary approaches in Le Fort I osteotomy: An experimental study. Med Oral Patol Oral Cir Bucal 2017; 22:e371-e376. [PMID: 28390129 PMCID: PMC5432087 DOI: 10.4317/medoral.21663] [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: 10/02/2016] [Accepted: 01/02/2017] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this experimental study was to measure stresses both on the pterygoid plates and the skull base following two different pterygomaxillary approaches in Le Fort I osteotomy. Material and Methods The prepared skull models were randomly divided into 2 groups of 7. In the first group (A), the pterygomaxillary area was left intact. In the second group (B), pterygomaxillary separation was performed with a fine bur. The stresses were measured by using strain gauges. These strain gauges were attached to 6 different anatomical sites. The skull models were mounted on a servo-hydraulic testing unit. Each model was then subjected to a continuous linear tension until a plastic deformation was seen. Results The statistical analyses showed that there were no significant differences (p >.05) between the 2 groups regarding the strain values. Moreover, no statistical differences (p >.05) were found between the two groups in terms of maximum applied forces. Conclusions Considering the clinical conditions, the present study shows that when Le Fort I osteotomy performed without pterygomaxillary separation, there is no significant stress on the skull base during the downfracture. Moreover, it is considered that there is no need for an excessive force applied to perform downfracture in Le Fort osteotomies without pterygomaxillary separation. Key words:Le Fort I, osteotomy, strain, base of skull, pterygoid process.
Collapse
Affiliation(s)
- Y-B Ozdemir
- Necmettin Erbakan Universitesi, Dis Hekimligi Fakultesi, Ankara Cd. No:74/A, Konya/Turkiye,
| | | | | | | | | |
Collapse
|
10
|
Abstract
The LeFort I osteotomy is one of the most commonly used procedures to correct midface deformities. It allows for correction in three dimensions including advancement, retrusion, elongation, and shortening. It is indicated, often in conjunction with mandibular surgery, for class II and III malocclusion, facial asymmetry, obstructive sleep apnea, and maxillary atrophy. Before surgery, proper orthodontics and surgical planning should be undertaken to ensure adequate outcomes. Overall, the surgery is widely used due to its low complication profile and reliable long-term results.
Collapse
Affiliation(s)
- Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charles H Hyman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
11
|
Kang S, Jang SY, Lee A, Jang JW. Loss of reflex tearing after maxillary orthognathic surgery: a report of two cases. BMC Ophthalmol 2014; 14:37. [PMID: 24673800 PMCID: PMC3974743 DOI: 10.1186/1471-2415-14-37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 03/19/2014] [Indexed: 11/14/2022] Open
Abstract
Background Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery. Case presentation Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients. Conclusions The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy.
Collapse
Affiliation(s)
| | | | | | - Jae Woo Jang
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Youngdeungpo 4th 156, Youngdeungpo-gu 150-034, Seoul, Korea.
| |
Collapse
|