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Mendes BM, Bortoli ÉS, Zaleski CB, Martinelli MPD, Pascoal VF, Oliveira SD. Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy. BMC Oral Health 2024; 24:533. [PMID: 38704542 PMCID: PMC11069297 DOI: 10.1186/s12903-024-04295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.
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Affiliation(s)
- Bárbara M Mendes
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Évelin S Bortoli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Catherine B Zaleski
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Maila P D Martinelli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Vanessa F Pascoal
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Sílvia D Oliveira
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil.
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil.
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Ibrahim N, Hwang PH, Jitaroon K, Tyler MA. Chronic Rhinosinusitis After Maxillary Advancement Orthognathic Surgery. Ann Otol Rhinol Laryngol 2024; 133:261-267. [PMID: 37800544 DOI: 10.1177/00034894231204654] [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] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Maxillomandibular advancement (MMA) remains an effective procedure for the management of obstructive sleep apnea (OSA). Maxillary advancement may lead to anatomical changes that impair paranasal sinus drainage, leading to chronic sinus inflammation. The aim of this study was to describe the clinical features and outcomes of patients suffering from chronic rhinosinusitis (CRS) following MMA. METHODS This is a retrospective case series study. Our study included subjects diagnosed with CRS following MMA from January 1992 to October 2018 at Stanford Hospital. We screened 730 patients undergoing MMA and identified a total of 57 with CRS after MMA. A descriptive analysis was performed using clinical data including patient demographics, comorbidities, prior surgical history, physical exam manifestations, CT findings, and quality of life outcomes (SNOT-22). RESULTS Out of 730 patients undergoing MMA, 57(7.8%) were found to have CRS after orthognathic surgery. Presenting symptoms included facial pain (92.5%), nasal drainage (75%), nasal obstruction (67.5%), and hyposmia (20%). Endoscopic examination revealed recirculation (30.5%), purulent discharge (27.7%), polypoid changes (22.2%), and scarring (13.8%). Preoperative CT prior to undergoing endoscopic sinus surgery (ESS) demonstrated mucosal thickening in maxillary (64.2%), anterior ethmoid (39.2%), frontal (14.2%), posterior ethmoid (10.7%), sphenoid sinus (14.2%), and ostiomeatal complex (55.3%). Average Lund-Mackay score was 5.5(±3.8). Additional CT findings included secondary ostium in the inferior meatus (42.8%). Forty patients (70.1%) underwent ESS at a mean of 4.6 years after MMA. Patients undergoing ESS experienced significant improvement in SNOT-22 scores at 12-months post-surgery (P = .018). CONCLUSION Patients undergoing maxillary advancement surgery are at risk of developing CRS postoperatively and should be advised of the risk of CRS associated with this procedure. Surgical treatment can be an option for medically refractory CRS related to MMA surgery.
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Affiliation(s)
- Nour Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Bar Ilan University, Ramat Gan, Tel Aviv, Israel
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kawinyarat Jitaroon
- Department of Otolaryngology, Navamindradhiraj University, Bangkok, Thailand
| | - Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Talugula S, Johnson V, Zhao L, Patel P, Lee V. Incidence of Sinusitis Postoperatively in Orthognathic Surgery: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:143-146. [PMID: 37681995 DOI: 10.1097/scs.0000000000009738] [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: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Maxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior component of the sinus leaves a bony and mucosal opening in the sinus. Immediately after surgery, nasal drainage is impeded because of intranasal swelling. Acute and chronic maxillary sinusitis would be expected; however, its incidence as an expected complication is not well documented. A systematic review and meta-analysis was completed using PubMed to determine the incidence of sinusitis after maxillary orthognathic surgery. Studies were reviewed by two authors, and incidence data were extracted. Two hundred six articles were identified with 24 meeting the criteria for analysis. The incidence of sinusitis was based on 4213 participants who had undergone orthognathic surgery. Twenty-three studies reported a total number of sinusitis cases, and the results demonstrated a pooled incidence of 3.3% (95% confidence interval: 1.77, 6.06). One study did not report a total number of cases but reported chronic sinusitis survey-duration-based and Lund-Mackay scores. These scores, respectively, worsened from 7.6 to 14.8 and from 1.58 to 2.90 postoperatively. Despite the variability of maxillary surgery, the surgical technique, and the postoperative management, the incidence is low but sinusitis does occur. Prospective studies with validated questionnaires within the context of a specific protocol may further elucidate the causality of sinusitis. Further, patients with sinonasal symptoms postsurgery should be encouraged to consult with an otolaryngologist to ensure prompt treatment.
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Affiliation(s)
- Snehitha Talugula
- Department of Otolaryngology - Head and Neck Surgery, University of Illinois Chicago
| | - Vickie Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Illinois Chicago
| | - Linping Zhao
- Department of Plastics, Reconstructive and Cosmetic Surgery, The Craniofacial Center, University of Illinois Chicago
- Shriners Children's Chicago Chicago, IL
| | - Pravin Patel
- Department of Plastics, Reconstructive and Cosmetic Surgery, The Craniofacial Center, University of Illinois Chicago
- Shriners Children's Chicago Chicago, IL
| | - Victoria Lee
- Department of Otolaryngology - Head and Neck Surgery, University of Illinois Chicago
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Eshghpour M, Vaezi T, Samieirad S, Manafi A, Ebrahimpour A, Shams A. Assessment of Maxillary Sinus Variations Post-LeFort: A Systematic Review. World J Plast Surg 2023; 12:3-10. [PMID: 38226188 PMCID: PMC10788108 DOI: 10.61186/wjps.12.3.3] [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: 07/22/2023] [Accepted: 11/25/2023] [Indexed: 01/17/2024] Open
Abstract
Background The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred following LeFort I osteotomy, as well as the abnormalities of maxillary sinus volume (MSV) before and after the operation. Methods A systematic search was conducted on various databases, such as Google Scholar, PubMed, and Scopus. The articles used were in English and original. This study was conducted until September 2023, and after reviewing the articles, several keywords, such as "Maxillary sinus" and "LeFort I osteotomy", were employed. The obtained data were evaluated based on the PICO framework. Results Findings from 15 studies showed that the amount of MSV decreased before and after the operation (considering the three dimensions of the sinus, the measurement was performed linearly). These reduction values differed between men and women, with men having a greater reduction. As is the case with other operations, there were some side effects associated with this type of operation that some patients experienced postoperatively. Conclusion In both male and female patients, the MSV was reduced after one-piece and multi-segment osteotomies. Nonetheless, one-piece LeFort I osteotomy showed a higher reduction in MSV than the multi-segment osteotomy method, according to this systematic review and meta-analysis.
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Affiliation(s)
- Majid Eshghpour
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Touraj Vaezi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Sahand Samieirad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Ali Manafi
- Department of Plastic Surgery, Iran university of Medical Sciences, Tehran, Iran
| | - Alireza Ebrahimpour
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Abdolrahim Shams
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
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