Does the Type of Maxillomandibular Deformity Influence Complication Rate in Orthognathic Surgery?

A Novel Interdisciplinary Approach for the Management of Micrognathia (Brodie Syndrome)

This study describes a multidisciplinary approach for correcting a severe Class II malocclusion with reduced mandibular transverse dimension. A 35-year-old woman presented with an increased overjet, complaining chiefly of forwardly placed upper front teeth and unpleasant smile esthetics. The patient had a convex profile with severe mentalis strain on lip closure. Intraoral examination indicated a bilateral Class II canine relationship, scissor bite, and narrow lower arch. The skull lateral view assessment revealed a skeletal Class II relationship with reduced lower facial height. According to the diagnostic records and after consultation with the patient, surgically assisted expansion of the mandibular symphysis with a bone distractor, comprehensive orthodontic treatment, and combined jaw surgery were planned, followed by dental implant placement and prosthetic full-mouth rehabilitation. Restorative dentistry, orthodontics, and orthognathic surgery were the 3 disciplines that helped in achieving the best esthetic and functional results in this patient.

Does leucocyte- and platelet-rich fibrin enhance neurosensory recovery after genioplasty? A double-blind, split-mouth, randomised clinical trial

Neurosensory disturbances (NSD) are common after genioplasty. In this study we aimed to assess the recovery of NSDs with or without leukocyte- and platelet-rich fibrin (L-PRF) following genioplasty. In this double-blind, split-mouth, randomised clinical trial, L-PRF was applied around the mental nerve at the osteotomy site in genioplasty (treatment side). The contralateral side was considered the control side. Two-point discrimination (TPD) test, brush test, and self-reported NSDs (SR-NSD) were used to determine NSD at one, four, and 12 months after genioplasty. Twenty patients were studied. At one and four months after osteotomy, the mean scores of TPD and SR-NSDs were significantly different between the treatment and control sides (p = 0.04, p = 0.01, respectively). The mean of TPD and SR-NSDs was not statistically different on both sides 12 months after operation (p = 0.05, p = 0.71, respectively). The application of L-PRF may enhance the speed of NSD recovery four months after genioplasty.

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

BACKGROUND

Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications.

METHODS

We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications.

RESULTS

The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009).

CONCLUSION

Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.

Complications associated with orthognathic surgery: A retrospective study of 485 cases

PURPOSE

To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors.

METHODS

This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05.

RESULTS

A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05).

CONCLUSION

Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.

Evaluating the July Effect in Oral and Maxillofacial Surgery: Part II-Orthognathic Surgery

PURPOSE

The purpose of this study was to determine if there is an increased postoperative complication rate in orthognathic surgery during the first academic quarter (Q1) (July to September).

MATERIALS AND METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was accessed to identify cases with Current Procedural Terminology codes pertaining to orthognathic procedures from 2008 to 2017. Procedures were separated into 2 groups based on time in the academic year: Q1 (July to September) versus remaining quarters (RQ). The inclusion criteria were Current Procedural Terminology codes representing operations resulting in movement of the dentate portion of the jaws and age of 18 years or older. Patient demographic characteristics and perioperative complications were compared between the groups. Descriptive statistics, Fisher exact tests, and χ² tests were executed.

RESULTS

The Q1 cohort included 877 cases, and the RQ cohort included 2,062 cases. The average age of patients was 47.0 ± 19.5 years in Q1 versus 47.2 ± 19.4 years in RQ. The most frequent complications were blood transfusion (11.97% in Q1 vs 12.57% in RQ, P = .64), reoperation (8.67% in Q1 vs 8.84% in RQ, P = .87), and combined superficial and deep-space infection (5.02% in Q1 vs 5.76% in RQ, P = .51). Medical complications involving other organ systems were rare (<1%). Analyses showed no significance between complication rate and time of year.

CONCLUSIONS

The results of this study indicate that there is no association between time of year and complication rates after orthognathic surgery. Additional investigations could be useful in shining light on this topic as it pertains to the training of future surgeons.

Length of Stay and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter?

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.