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Biomedical subjects

R A West

Publications and source records attributed to R A West.

At least 19 recordsLinked to original sources
PubMed1991

Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery.

False aneurysms and arteriovenous fistulas are rare complications of orthognathic surgery. The vessel most commonly involved with false aneurysms following mandibular surgery is the internal maxillary artery, and this vessel, especially the sphenopalatine branch, may also be involved following maxillary surgery. An unusual factor in the presentation of false aneurysms following Le Fort I osteotomies is an initial episode of epistaxis occurring greater than 2 weeks postoperatively. Arteriovenous fistulas following orthognathic surgery are more apt to involve large vessels, especially the internal carotid artery. Embolization procedures are the treatment of choice for false aneurysms and arteriovenous fistulas in the maxillofacial region following orthognathic surgery.

Adolescent↗
PubMed1991

Hemorrhage following mandibular osteotomies: a report of 21 cases.

Hemorrhage associated with mandibular osteotomies, especially to the extent that it becomes life threatening, is a rare occurrence and its risk is less than that following maxillary orthognathic surgery. Twenty-one cases of significant bleeding following mandibular sagittal split ramus osteotomies, vertical and oblique ramus osteotomies, and genioplasties are presented. Life-threatening hemorrhage associated with mandibular osteotomies is primarily an intraoperative problem and the incidence of major postoperative and recurrent hemorrhage is not as great as following maxillary osteotomies. Suggestions for the avoidance and treatment of these bleeding complications are discussed.

Adolescent↗
PubMed1990

Aseptic necrosis of the mandible: report of two cases.

It appears that clinically significant aseptic necrosis following mandibular osteotomies is a more infrequent occurrence than that following maxillary surgery because only two cases were reported in a questionnaire dealing with major vascular complications following orthognathic surgery. Significant necrosis is unlikely to occur if a surgeon follows the basic principle of stripping the minimal amount of mucoperiosteum and muscle attachment from the osteotomized segments commensurate with the successful completion of the osteotomies.

Adult↗
PubMed1990

Aseptic necrosis following maxillary osteotomies: report of 36 cases.

The sequelae of insufficient vascularity following maxillary orthognathic surgery can vary from loss of tooth vitality, to periodontal defects, to tooth loss, to loss of major maxillary dentoalveolar segments. The results of a questionnaire mailed to oral and maxillofacial surgeons found this complication was most likely to occur with Le Fort I osteotomies done in multiple segments in conjunction with superior repositioning and transverse expansion. Significant palatal perforations definitely seem to compromise the already tenuous blood supply to the anterior maxilla. Suggestions are given regarding the prevention and treatment of this complication.

Adolescent↗
PubMed1990

Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies.

Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venous and/or arterial in nature. Arterial hemorrhage generally involves the maxillary artery and its terminal branches. Arterial hemorrhage tends to be more persistent and can be recurrent, which makes it more difficult to manage. Postoperative bleeding following Le Fort I osteotomies generally presents as epistaxis and usually occurs initially within the first 2 weeks following surgery. Treatment modalities that have been used to successfully arrest postoperative hemorrhage include anterior and/or posterior nasal packing; packing of the maxillary antrum; reoperating with clipping or electrocoagulation of bleeding vessels, or the use of topical hemostatic agents in the pterygomaxillary region; external carotid artery ligation; and selective embolization of the maxillary artery and its terminal branches.

Adolescent↗
PubMed1989

Ptosis of the chin and lip incompetence: consequences of lost mentalis muscle support.

Ptosis of the chin and lip incompetence are worrisome complications of surgery in the mandibular symphyseal region. This article relates the normal anatomy and physiology of the muscles in this region to these complications. It suggests a sequence of surgical planning that can prevent them and also offers ways of dealing with the problems should they occur.

Adult↗
PubMed1989

Factors influencing the stability of the sagittal split osteotomy for mandibular advancement.

Relapse continues to be a potential problem with use of the sagittal split osteotomy to advance the mandible. In an effort to isolate predictive factors, the records of 235 patients were analyzed to determine the pretreatment facial morphology, the amount of advancement, the amount of relapse, and the duration of relapse. No relationship was found between any of the measures of facial morphology and relapse. However, the amount of advancement, the amount of relapse, and the duration of relapse all were found to be strongly related. It was found that all patients shared a similar facial morphology, and thus no influence of facial form on relapse would be expected from this group. The relationships between advancement and relapse could be attributed to neuromuscular adaptation, which would be more prolonged and more extensive in instances of greater advancement, and thus give rise to relapse of greater extent and duration. It is therefore suggested that mandibular advancements of greater than 10 mm be fixed more rigidly and for a greater length of time than those of lesser magnitude.

Adolescent↗
PubMed1988

Jaw deformity caused by juvenile rheumatoid arthritis and its correction.

An underdeveloped mandible and resulting micrognathia and malocclusion may occur in some children with juvenile rheumatoid arthritis. Combined orthodontic and surgical procedures can now greatly improve esthetics and function in such children. We describe corrective treatment and followup of 7 patients.

Adolescent↗
PubMed1986

Personality characteristics as predictors and sequelae of surgical and conventional orthodontics.

The aims of this study were to determine the effects of surgical and conventional orthodontics on patients' body image and self-esteem and the association between personality characteristics and postoperative reports of pain, paresthesia, swelling, and satisfaction among 90 patients who underwent surgical orthodontics. Patients who underwent surgery completed questionnaires before their operations and up to 6 months after surgery. Self-esteem and body image were compared longitudinally between these patients and 33 persons who were undergoing orthodontic treatment only and 33 persons who had decided against treatment. Results suggest that patients' self-esteem, body image, and degree of extroversion are unrelated to postsurgical satisfaction and discomfort. Neuroticism was correlated with satisfaction, so that patients who scored in the higher range on a scale of neuroticism were less satisfied immediately after surgery and at removal of fixation wires. Neurotic patients also were more likely to complain of pain and swelling 6 months after surgery. Surgical patients held a more negative facial image and were more introverted than those in the other two groups but were similar in other personality traits before surgery. Both surgical and orthodontic patients improved significantly in body image over time, with the greatest increase among the former. Similar shifts in self-esteem occurred for the three groups, suggesting that surgery per se may not be the major determinant of longitudinal changes in self-esteem. Notably, the positive effect of surgery and orthodontic treatment on body image is an important motive for many persons seeking treatment. Results of this study provide important insights into how to prepare and counsel patients undergoing orthodontic treatment with and without surgery.

Body Image↗
PubMed1985

Mandibular advancement surgery. A study of the lower border wiring technique for osteosynthesis.

A study was undertaken to evaluate the effectiveness of osteosynthesis achieved by a lower border wire technique. Fifty patients who underwent mandibular advancement surgery were examined cephalometrically during 6 weeks of maxillomandibular fixation. A detailed analysis was made of spatial changes in the proximal and distal segments following bilateral sagittal-split osteotomies.

Adolescent↗
PubMed1985

The emotional impact of orthognathic surgery and conventional orthodontics.

Previous research by the authors has pointed to depressive reactions among orthognathic surgery patients during the fixation-removal stage and up to 9 months later. However, less is known about emotional shifts among persons who choose to undergo conventional orthodontic treatment after considering surgical orthodontics. In the current study, a standard measure of mood states was applied to 90 surgical patients and 66 who had considered surgery but decided against it. Of these, 33 were undergoing orthodontic treatment and 33 were having no treatment. The mood scale and measures of personality were first applied before surgery and then during orthodontic treatment, just after surgery, at fixation removal, and 6 months after surgery. Nonsurgical respondents completed questionnaires at the same time as their matched surgical respondents. Scores on tension and fatigue increased significantly among surgical patients from before surgery to immediately after surgery and dropped to presurgical levels when fixation was removed. Anger-hostility increased at fixation removal but declined within 5 months. Postsurgical discomfort, pain, and paresthesia, and interpersonal and oral function problems were correlated with postsurgery emotional state. On the later questionnaires, which corresponded to the later periods of orthodontic treatment, patients who had opted for conventional orthodontic treatment reported that they experienced greater depression, anger, and tension. These patients may be particularly vulnerable to emotional problems because their orthodontic treatment may be more complex and of longer duration than that of the typical orthodontic patient. These results point to the importance of continued psychological support for both orthodontic and surgical patients throughout their course of treatment.

Adolescent↗
PubMed1984

Psychologic changes in orthognathic surgery patients: a 24-month follow up.

This report describes the final, two-year follow up in a longitudinal study of 74 patients who underwent orthognathic surgery for developmental deformities. Data for all six measurement periods were available for 46 patients. Complaints of functional problems decreased significantly from before surgery to 24 months after, although 49% of the patients continued to report lip paresthesia. The incidence of postsurgical problems had no effect on the satisfaction expressed with surgical outcomes, which remained high throughout the postoperative course. Self-esteem appeared to rise in anticipation of surgery, only to decline significantly at nine months after surgery, to rise again by 24 months (but not as high as before surgery). In some components, self-esteem remained significantly lower after surgery than before. Body image also showed a decline at nine months, although overall body image and profile image 20-26 months after surgery were significantly more positive than before surgery. These results point to the importance of continued contact with orthognathic surgery patients by surgeons and orthodontists for at least two years after surgery, particular attention being paid to the intermediate stages (six to 12 months) after surgery. This period of psychologic upheaval appears to be related to the patient's desire to complete postsurgical orthodontics.

Adolescent↗
PubMed1984

Condylar position following mandibular advancement: its relationship to relapse.

Forty-one patients who elected to receive a bilateral sagittal osteotomy to advance the mandible were examined clinically and radiographically to assess condylar position preoperatively and at three specific times postoperatively. Parameters designed to measure changes in condylar and distal fragment position were located on tracings and digitized for statistical analysis. Changes in distal fragment position included advancement and clockwise rotation during the surgical interval and significant posterior relapse with continued clockwise rotation during the period of maxillomandibular fixation. A small amount of counterclockwise rotation associated with interocclusal splint removal was seen following fixation release. No significant condylar movement was seen during the surgical interval. During the period of maxillomandibular fixation, both condyles exhibited a significant superior movement, and the left condyle also moved posteriorly. No changes in condylar position were noted following release of fixation. The clinical significance of these condylar movements is not clear. Despite minimal changes, 18 patients, six of whom had had no preoperative symptoms and one of whom had exhibited reciprocal clicking, complained of temporomandibular joint pain or noise postoperatively. This suggests that maintenance of condylar position during surgery may not prevent temporomandibular joint dysfunction. In addition, the observed 37% relapse in surgical advancement in the absence of significant condylar distraction implies the interaction of other factors in the relapse process.

Adolescent↗
PubMed1984

Orthodontics and orthognathic surgery: adjuncts to restorative and periodontal therapy.

Orthodontic and orthognathic surgical procedures are important adjuncts to the provision of optimum restorative and periodontal care. Dentoalveolar and skeletal abnormalities of either developmental or acquired origin can be corrected primarily, thus eliminating the necessity for compromise in prosthetic design. Dental relationships that are contributory to irreversible periodontal deterioration can be normalized to facilitate stabilization of the periodontal condition and to increase the longevity of the natural dentition. Maxillofacial surgical treatment is technically complex but is more conservative than many traditionally accepted treatment procedures. It is based on the rationale of conservation of natural structures rather than their radical ablation or their sacrifice to uncontrollable progressive disease processes. Patient participation to establishment of treatment objectives and extensive patient education are essential ingredients in such treatment. Interdisciplinary communication and coordination contribute to a mutual appreciation of treatment possibilities and limitations. Thus, orthodontic and orthognathic surgical options should be considered in planning the solution to a wide variety of periodontal and restorative treatment problems.

Adult↗
PubMed1983

Recreational and social activities of orthognathic surgery patients.

The present study examined changes in recreational and social activities after orthognathic surgery. Because this is often an expectation of patients seeking surgery, it was hypothesized that activity levels would increase gradually after surgery, particularly for patients who become more extroverted and for unmarried patients. Information on the frequencies of recreational and social activities, and the persons with whom these activities were performed, were obtained from 53 patients in a self-administered questionnaire administered at least 2 days before surgery and again 3 weeks, 4 months, and 9 months after surgery. In addition, patients were assessed on introversion-extroversion before and after surgery. The results indicated that (1) for both married and single patients, recreational and social activities dropped immediately after surgery and gradually increased to a level similar to that prior to surgery at nine months after surgery; (2) contrary to expectations, the single patients over age 15 did not increase their recreational and social activities with friends of the opposite sex after surgery; and (3) the degree of change in introversion-extroversion after surgery was not associated with the degree of change in recreational and social activities performed with others. Implications for postsurgical adjustment of orthognathic patients and recommendations for future research are discussed.

Adolescent↗