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At least 19 recordsLinked to original sources
PubMed1995

Average blood loss and the risk of requiring perioperative blood transfusion in 506 orthognathic surgical procedures.

PURPOSE: This study quantifies the estimated blood loss in seven groups of orthognathic surgical procedures and the risk of requiring perioperative blood transfusion, and identifies the factors relating to blood loss and need for transfusion. PATIENTS AND METHODS: The records of 506 consecutive patients who underwent various orthognathic surgical procedures under hypotensive anesthesia from 1987 to 1990 were analyzed retrospectively. All procedures were performed by the authors in the same hospital setting. Patients were placed in seven groups based on the operation(s) performed, including single-jaw and double-jaw procedures. Estimated blood loss was calculated for each group and was correlated with patients' sex, age, and year of surgery, and whether they autodonated blood. The volume of intravenous (IV) fluids given was also recorded. RESULTS: Average estimated blood loss for all groups was 273.23 mL. Double-jaw procedures resulted in more blood loss than single-jaw procedures. Men and boys had a higher average blood loss than women and girls, but average blood loss was not affected significantly by patients' age or year of surgery. Only four patients (0.8%) received blood transfusions, and their average estimated blood loss was 975 mL. The percentage of patients autodonating increased from 10.4% in 1987 to 54.9% in 1990. There was no significant difference in the percentage of autodonators by surgical procedure. CONCLUSIONS: The need for blood transfusion in this study was extremely low. Factors contributing to this are believed to be use of hypotensive anesthesia; a single surgical team; and a constant surgical setting. Patients having double-jaw surgery are at greater risk for blood loss than those having single-jaw procedures, and should be so advised, along with the risks of blood transfusion. The authors believe that under the conditions of this study the use of autodonation is not necessary, with the possible exception of complex double-jaw procedures involving small patients.

Adolescent↗
PubMedDate not supplied

Low frequency of adenylate kinase release into cerebrospinal fluid during balanced, normotensive anaesthesia and a non-orthognathic surgical procedure.

Activity of strictly intracellular enzymes in the cerebrospinal fluid (CSF) may indicate leakage from dysfunctional brain cells. Increased activity of adenylate kinase (AK) in the CSF is indicative of brain cell injury arising from several sources, among them orthognathic surgery. The mechanism in the latter case is obscure, but the use of an oscillating saw which generates vibrations, and the site of surgery close to the brain may be contributing factors. Anaesthesia may also play a role. In the present study, CSF-AK activity was measured after hysterectomy and was compared with activity after orthognathic surgery in two other studies. Four of 19 patients (21%) in the present study expressed pathological activity, compared with 34 of 47 (72%) orthognathic patients in the two other studies. No firm conclusion may be drawn from historical comparisons, and the difference in activity seen between the two types of surgery might not necessarily be the result of surgical factors. Until this is investigated further, however, we conclude that there may be a difference in postoperative CSF-AK activity between orthognathic and lower abdominal surgery.

Adenylate Kinase↗
PubMed1984

A survey of complications in segmental orthognathic surgical procedures.

This article is a summary of responses of oral-maxillofacial surgeons to a questionnaire related to their experiences in dentoalveolar segmental osteotomy surgery. It is presented as an evaluation of complications and as an overview of medications, splinting techniques, and suggestions on measures to avoid future complications.

Humans↗
PubMed1996

Orthognathic surgery: a hierarchy of stability.

The stability and predictability of orthognathic surgical procedures varies by the direction of surgical movement, the type of fixation, and the surgical technique employed, largely in that order of importance. The most stable orthognathic procedure is superior repositioning of the maxilla, closely followed by mandibular advancement in patients in whom anterior facial height is maintained or increased. (If facial height is decreased by upward rotation of the chin, stability is compromised). The combination of moving the maxilla upward and the mandible forward is significantly more stable when rigid internal fixation is used in the mandible. Forward movement of the maxilla is reasonably stable, with or without rigid internal fixation, but mandibular setback often is not stable, and downward movement of the maxilla that creates downward rotation of the mandible is unstable. For mandibular setback, the inclination of the ramus at surgery appears to be an important influence on stability. It has been suggested that both interpositional synthetic hydroxyapatite grafting and simultaneous ramus osteotomy improve the stability of downward movement of the maxilla, but this has not been well documented. In two-jaw Class III surgery, the stability of each jaw appears to be quite similar to that of isolated maxillary advancement or mandibular setback. The least stable orthognathic procedure is transverse expansion of the maxilla. Although surgically assisted rapid palatal expansion has been suggested as a more stable alternative to segmental Le Fort I osteotomy, the patterns of movement resulting from the two procedures are different, and differences in stability have not been established.

Humans↗
PubMed1996

Community hospital charges for orthognathic surgery.

Hospital charges for orthognathic surgery with rigid fixation were evaluated for 80 patients from a community surgical practice. Although the surgeon can control to some degree the length of stay and charges for room and board, ancillary services, laboratory, radiology, and medicine by altering practice patterns, these charges together are less than 24% of the hospital bill. Seventy-six percent of the total hospital charges are generated in the operating room (i.e., operating room, anesthesia, recovery, and respiratory apparatus). Surgeons have minimal control over these changes. Further negotiations with private and government third parties about reimbursement for orthognathic surgical procedures require a cooperative effort between the hospital and the surgeons.

Hospital Charges↗
PubMed2002

Use of conservative condylectomy for treatment of osteochondroma of the mandibular condyle.

PURPOSE: The aim of the present study was to present a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the head of the mandibular condyle. PATIENTS AND METHODS: Six patients (4 females and 2 males) with an average age of 22.3 years (range, 13 to 32 years) and with an osteochondroma of the mandibular condyle were treated with conservative condylectomy. The remaining condylar neck stump was recontoured, and the articular disc was repositioned and stabilized over the "new" condyle. Any indicated orthognathic surgical procedures were then performed to optimize occlusion, function, and aesthetics. Clinical and radiographic evaluation was performed before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3). RESULTS: Average follow-up for the patients was 51 months (range, 22 to 108 months). No recurrence of the tumor was encountered in any of the cases. Subjective and objective evaluations of postsurgical temporomandibular joint function and range of mandibular motion were normal. Associated maxillary and/or mandibular orthognathic procedures were found to be stable in the long term. CONCLUSION: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction.

Adolescent↗
PubMed1996

Mandibulofacial dysostosis: surgical treatment.

In six persons with mandibulofacial dysostosis, surgical correction of the anomaly was performed at different ages using different methods. In two persons between the ages of 7 and 9 years, correction of the zygomaticomaxillary region, using rib cartilage, was performed first. Later, at the age of 14 years, suitable orthognathic surgical procedures were done. In two patients at the ages of 16 and 17 years suitable orthognathic surgical procedures were performed first and correction of zygomaticomaxillary region, using rib cartilage, was performed 1 year later. In two 18-year-olds, the zygomaticomaxillary region was corrected using vascularized osteopericranial and additional pericranial flaps. In one of these two persons, suitable orthognathic surgical procedures had been performed a year before. The poorest results were obtained in two patients whose surgical treatment began at 7 to 9 years of age. The best results were obtained in those in whom suitable orthognathic surgical procedures were performed between 16 and 18 years of age with the correction of the zygomaticomaxillary region a year later.

Adolescent↗
PubMed2002

Concomitant temporomandibular joint and orthognathic surgery: a preliminary report.

PURPOSE: In the present study, we evaluated the outcome of concomitant temporomandibular joint (TMJ) and orthognathic surgery in patients with TMJ articular disc dislocation and coexisting dentofacial deformities. PATIENTS AND METHODS: The records of 70 patients treated with TMJ articular disc-repositioning surgery and concomitant orthognathic surgery (double jaw or only mandibular surgery) were retrospectively evaluated. Patients were divided into the following 3 groups: group 1 patients had mandibular advancement, group 2 patients had mandibular setback, and group 3 patients had a mandible that remained in the original position. Lateral cephalometric radiographs and lateral cephalometric tomograms were assessed at the following intervals: before surgery (T1), immediately after surgery (T2), 6 to 12 months after surgery (T3), and at the longest follow-up (T4). Lateral cephalometric tracings were superimposed to calculate surgical change (T2 - T1), short-term stability (T3 - T2), and long-term stability (T4 - T3) of the orthognathic surgery procedures. Maximum interincisal opening (MIO) and subjective TMJ pain (visual analog scales) were comparatively evaluated at T1 and T4. RESULTS: Subjective TMJ pain levels and MIO improved in all 3 groups after surgery. Before surgery, 56 of 70 patients (80%) had pain and 14 of 70 patients (20%) had no pain. At the longest follow-up, 42 of 70 patients (60%) reported complete relief of TMJ pain. Only 5 of 70 patients (7%) had severe pain after surgery compared with 37 of 70 patients (53%) before surgery. At the longest follow-up, 6 of 70 patients (9%) showed less than 35 mm MIO, residual severe pain, or both. One patient had significant condylar resorption after surgery. The orthognathic procedures were found to be stable in the long term. Concomitant TMJ and orthognathic surgery had an overall success rate of 91.4% based on a greater than 35 mm MIO and a decrease in pain. CONCLUSIONS: When indicated, TMJ and orthognathic surgery can be concomitantly performed with predictable results and a good success rate. Strong consideration should be given to early surgical intervention because the success rate decreases significantly with pre-existing TMJ dysfunction of greater than 48 months' duration.

Adolescent↗
PubMed1999

Current concepts in aesthetic orthognathic surgery.

While orthognathic surgery provides a significant improvement in masticatory, dentofacial, and airway function, proper and considered preoperative planning can significantly enhance facial harmony and balance as well. Also, orthognathic procedures to correct underlying skeletal discrepancies in concert with, or prior to, other cosmetic procedures can greatly enhance the patient's final result. This paper reviews the use of the occlusal plane angle as a guide for improved aesthetic results with bimaxillary orthognathic surgery. It also provides several examples of facial cosmetic procedures performed as an adjunct to dentofacial surgery. A rationale of timing of these procedures is offered.

Adult↗
PubMed1999

Alternative methods for reduction of blood loss during elective orthognathic surgery.

Bimaxillary orthognathic surgery and genioplasty are frequently performed to correct dentoskeletal anomalies in otherwise healthy young patients. Until 1990 homologous blood transfusions were routinely necessary for these procedures. The present study describes a protocol of blood-saving measures that was adopted and tested on a continuous sample of 127 patients treated between 1994 and 1997. The protocol comprises acute normovolemic hemodilution, controlled moderate hypotension, positioning the surgical field above the heart level, cell saving, intraoperative homeostasis, preoperative autologous blood donation, administration of recombinant erythropoietin, and acceptance of a low hematocrit perioperatively. This study shows that homologous blood transfusions may be avoided intraoperatively by following the protocol described.

Blood Loss, Surgical↗
PubMed1999

Prediction accuracy of soft tissue profile in orthognathic surgery.

The purpose of this study was to compare soft tissue prediction accuracy of model surgery combined with computer software prediction with that of computer software prediction alone and to assess surgical accuracy by comparing the immediate postsurgical cephalogram with the planned movement of skeletal hard tissue. The predicted and actual soft tissue changes and the corresponding skeletal changes of 16 patients were compared using the Quick Ceph Image cephalometric treatment simulation software. A custom analysis was created to measure the hard tissue and soft tissue changes that occurred as a result of the surgical procedure. On average, the predictions were not significantly different from the actual postsurgical profile changes. Surgical changes of hard tissues from presurgery to postsurgery were accurate as planned except for the position of N-ANS. All lower soft tissue points moved significantly during treatment. Quick Ceph Image offers a rapid and reliable method of profile prediction that does not require artistic skill. If predictions are interpreted with caution and transferred accurately to the model surgery, they can provide an excellent visual aid during presurgical treatment planning and patient presentation.

Adolescent↗
PubMed2000

Use of a resorbable fixation system in orthognathic surgery.

We present our early experience with the use of a resorbable plating system in orthognathic surgery. Thirty-one patients who have finished growing and who had dentofacial deformities that were not part of syndromes were treated by routine orthognathic repositioning procedures: maxillary (n = 8) and mandibular (n = 9) osteotomies, or bimaxillary procedures (n = 14). All skeletal fragments were fixed with resorbable plates and screws. The follow-up period ranged from 2-8 months (mean 5). All the patients recovered normally except for one who developed a localized buccal space infection. In the early postoperative period, six patients had mild mobility of the maxilla, but stability was within normal limits at six weeks postoperatively. We conclude that, though technique has an important influence on success, LactoSorb is a good fixative for maxillo-mandibular repositioning.

Absorbable Implants↗
PubMed2000

Computer-assisted three-dimensional surgical planing and simulation. 3D soft tissue planning and prediction.

The purpose of this paper is to report a new technique for three-dimensional facial soft-tissue-change prediction after simulated orthognathic surgical planning. A scheme for soft tissue deformation, "Computer-assisted three-dimensional virtual reality soft tissue planning and prediction for orthognathic surgery (CASP)", is presented. The surgical planning was based on three-dimensional reconstructed CT visualization. Soft tissue changes were predicted by two newly devised algorithms: Surface Normal-based Model Deformation Algorithm and Ray Projection-based Model Deformation Algorithm. A three-dimensional color facial texture-mapping technique was also used for generating the color photo-realistic facial model. As a final result, a predicted and simulated patient's color facial model can be visualized from arbitrary viewing points.

Algorithms↗
PubMed2002

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures.

BACKGROUND: This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV. TYPES OF STUDIES REVIEWED: MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing. RESULTS: The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions. CLINICAL IMPLICATIONS: Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Blood transfusion requirements in bimaxillary osteotomies.

The over-ordering of cross-matched blood to cover operations can result in blood shortages and is costly; it can never be free of risk. Current published guidelines recommend cross-matching 2 units of blood for bimaxillary orthognathic procedures with an additional 2 units if combined with a genioplasty. We reviewed the records of 115 consecutive cases of simultaneous bimaxillary osteotomies at Morriston Hospital over a 5-year period (January 1996 to December 2000). Ordering and use of blood were investigated and the cost analysed. Blood loss was minimised using a strategy of controlled moderate hypotension and meticulous haemostasis. Nine patients were given transfusions of blood but five of these were deemed inappropriate. No predisposing factors for transfusion were identified. We recommend that the tariff for ordering blood for bimaxillary osteotomies should be revised to a "group and save" with antibody screen, providing that a 30-min indirect antibody cross-match is available.

Adolescent↗