The Stability of Anterior Open Bite Closure After Bimaxillary Osteotomy

Introduction

The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite.

Materials and Methods

A total of 11 patients with an anterior open bite treated with a combined surgical-orthodontic therapy were retrospectively analysed via lateral cephalometric radiographs and models before treatment, 7-10 days after surgery (T1), one year post-operatively (T2) and two years post-operatively (T3).

Results

Ten patients continued to experience a positive overbite at T2. This decreased to 8 at T3. Three patients experienced relapse and had a negative overbite at T3. The average pre-treatment overbite was greater in the positive overbite group compared to the relapse group. Spearman's correlation analysis revealed a correlation between preoperative maxilla-mandibular plane angle (MMPA) with the overall change in overbite. Friedman's test followed by Bonferroni post-hoc analysis was carried out to identify any statistical significance.

Conclusion

In conclusion, combined surgical-orthodontic treatment achieves good results for anterior open bite. Patients with a high pre-operative MMPA have a higher risk of relapse. Lower anterior facial height ratio to total anterior facial height (LAFH/TAFH) and the amount of impaction do not significantly contribute to the risk of relapse. Long-term stability of overbite for anterior open bite patients should be around 75%.

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia

OBJECTIVE

The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery.

METHODS

Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables.

RESULTS

Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours).

CONCLUSION

These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

Toward a higher accuracy in orthognathic surgery by using intraoperative computer navigation, 3D surgical guides, and/or customized osteosynthesis plates: A systematic review

The aim of this study was to systematically review the accuracy of intraoperative computer navigation, three-dimensional surgical guides and customized osteosynthesis plates for the transfer of the virtual surgical plan to the patient in orthognathic surgery. A systematic review of the currently available publications was performed in databases MEDLINE, Embase, and Cochrane Library, using a PICOS search strategy, and reported according to PRISMA. The initial search yielded 3050 articles. In total, 16 studies were included for final quantitative analyses. The results of individual studies demonstrated a comparable accuracy in the transfer of planned surgical displacement of the jaws. A large variability was found with regard to the method of accuracy assessment and reported outcomes. The findings of this review show that these modern techniques have the potential to replace interocclusal splints in routine clinical practice in the future. We recommend that authors presenting new data on the accuracy of a technique should choose the method of accuracy assessment meticulously, acquiring postoperative imaging as soon as possible after surgery. They should report as much as possible, summarizing values or, ideally, even the raw data of the accuracy assessment in order to allow comparison with other techniques in a meta-analysis.

Analgesic effects of nefopam in patients undergoing bimaxillary osteotomy: A double-blind, randomized, placebo-controlled study

PURPOSE

Many studies have examined the postoperative analgesic effects of nefopam in various settings. However, although nefopam is expected to be useful in bimaxillary osteotomy, no published data are available.

MATERIAL AND METHODS

We divided 42 patients into nefopam [n = 21, nefopam 20 mg intravenous (i.v.) 30 min before surgery, followed by an i.v. infusion (5 mg/h) beginning immediately postoperatively for 24 h] and control [n = 21, normal saline] groups. Then we compared the analgesic efficacy, side effects, and degree of patient satisfaction with postoperative analgesia.

RESULTS

Pain was lower in the nefopam group than in the controls in the recovery room [4.6 (3.0-6.0) vs. 6.0 (5.5-7.0), median (interquartile range), P = 0.002] and on the ward. Fewer patients in the nefopam group required rescue analgesics, and the degree of patient satisfaction was significantly higher in the nefopam group (P < 0.001). There were no significant differences in other side effects between the groups. However, the control group showed more sedation 1 h postoperatively (P = 0.009).

CONCLUSION

Nefopam is an effective analgesic in bimaxillary osteotomy in that it can reduce the use of opioids and nonsteroidal anti-inflammatory drugs, thereby reducing the side effects of conventional analgesics. (

TRIAL REGISTRATION

ClinicalTrials.gov (NCT 01461031)).

Efficacy of tranexamic acid on blood loss during bimaxilary osteotomy: A randomized double blind clinical trial

Background:

Tranexamic acid has been used to reduce bleeding and the subsequent need for blood transfusion in many surgeries. Because orthognathic surgery can be associated with significant bleeding, this study evaluated the efficacy of prophylactic intravenous (IV) tranexamic acid on blood loss during bimaxillary osteotomy.

Methods:

Thirty-two consecutive patients, scheduled for elective bimaxillary osteotomy, were included in the study and 16 were randomly assigned to each group. They received tranexamic acid (20 mg/kg) or equal volume of placebo (normal saline) intravenously just before induction of anesthesia. Intraoperative blood loss, pre and post operative hemoglobin (Hb) and hematocrit (Hct) concentration, duration of surgery, hospital stay time, and rate of blood transfusion were recorded for each patient.

Results:

Intraoperative blood loss in the tranexamic group and control group were 585.9 and 790 mL respectively (P=0.008). Postoperative Hb concentration at the 6^th hour was greater in the tranexamic group (P=0.008). There was no significant difference in the Hct concentration between the study groups. There was no significant difference in blood transfusion rate, hospital stay time and duration of surgery between the study groups.

Conclusion:

Preoperative IV administration of tranexamic acid reduces the amount of blood loss during bimaxillary osteotomy.