Yıl: 2023 Cilt: 29 Sayı: 1 Sayfa Aralığı: 15 - 21 Metin Dili: İngilizce DOI: 10.5336/dentalsci.2022-93092 İndeks Tarihi: 08-05-2023

Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research

Öz:
Objective: This paper investigated the incidence, types, and reasons for complications of orthognathic surgery (OS). Material and Methods: The sample consisted of the medical records of 250 OS (141 women; 109 men) patients from April 2011 to February 2017. This study retrospectively analyzed follow-up files, radiographic images, and surgery notes and then classified participants for gender, malocclusion type, OS method, and complication. Complications were classified as preoperative, intraoperative, and postoperative. Statistical analysis was performed using IBM SPSS Statistics 21.0 (IBM Corp, Armonk, NY, USA). Descriptive data were calculated for each variable. Results: The mean age was 22.9±6.5 (minimum: 17; maximum: 55). The majority of participants (n=166) had Class III dentofacial deformity. Only 24 participants underwent Le Fort I osteotomy alone (12%). Participants had undergone bimaxillary (n=167; 66.8%), single jaw surgery (Le Fort I or sagittal split ramus osteotomy) (n=48; 19.2%), or other types of surgery (n=35; 14%). The patients were followed up for 12 months in the postoperative period. The only preoperative complication (4 patients-1.4%) was errors in planning (occlusal split incompatibility). The major intraoperative complications (38 patients-15.2%) were bad splits, heavy bleeding, and ruptured inferior alveolar neurovascular bundle. The postoperative complications (43 patients-17.2%) were infection, fixation-related problems, neurosensory and temporomandibular joint disorders, facial paralysis, nasal septum deviation, and malunion-nonunion. The total rate of complications was 27.2% (68 patients). Conclusion: OS operations are generally safe operations that can be easily managed, although they may rarely cause serious life-threatening complications.
Anahtar Kelime:

Ortognatik Cerrahi Komplikasyonlarının Nedenleri ve Literatür Karşılaştırılması: Retrospektif Kohort Araştırma

Öz:
Amaç: Bu çalışmada, ortognatik cerrahi komplikasyonlarının insidansı, tipleri ve nedenleri araştırıldı. Gereç ve Yöntemler: Çalışma kapsamı, Nisan 2011-Şubat 2017 tarihleri arasında 250 ortognatik cerrahi hastasına (141 kadın; 109 erkek) ait tıbbi kayıtlarından oluşmaktadır. Bu çalışma ile hastaların geriye dönük takip dosyaları, radyografik görüntüleri ve ameliyat notları analiz edildi. Hastalar cinsiyet, maloklüzyon tipi, ortognatik cerrahi yöntemleri ve komplikasyon çeşitlerine göre sınıflandırdı. Komplikasyonlar preoperatif, intraoperatif ve postoperatif olarak belirlendi. İstatistiksel analiz, IBM SPSS Statistics 21.0 (IBM Corp, Armonk, NY, ABD) kullanılarak yapıldı. Her bir değişken için tanımlayıcı veriler hesaplandı. Bulgular: Yaş ortalaması 22,9±6,5 (minimum: 17; maksimum: 55) idi. Hastaların büyük çoğunluğunda (n=166) Sınıf III dentofasiyal deformite mevcuttu. Sadece 24’üne tek başına Le Fort I osteotomisi uygulandı (%12). Hastalara bimaksiller (n=167; %66,8), tek çene cerrahisi (Le Fort I veya sagittal split ramus osteotomisi) (n=48; %19,2) veya başka tip ortognatik cerrahi (n=35; %14) yöntemleri uygulandı. Hastaların ameliyat sonrası dönemdeki takipleri 12 ay boyunca yapıldı. Ameliyat öncesi tek komplikasyon (4 hasta-%1,4) planlama hatalarıydı (okluzal split uyumsuzluğu). Başlıca intraoperatif komplikasyonlar (38 hasta -%15,2) kötü bölünmeler, ağır kanama ve inferior alveolar nörovasküler damar sinir paketinin yırtılmasıydı. Postoperatif komplikasyonlar (43 hasta- %17,2); enfeksiyon, fiksasyona bağlı problemler, nörosensör ve temporomandibular eklem bozuklukları, fasiyal paralizi, nazal septum deviasyonu ve malunion/nonuniondu. Toplam komplikasyon oranı %27,2 (68 hasta) olarak tesbit edildi. Sonuç: Ortognatik cerrahi ameliyatları nadiren hayatı tehdit edici ciddi komplikasyonlara neden olabilse de genel olarak kolay yönetilebilen güvenli operasyonlardır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Wolford LM, Fields RT. Surgical planning. In: Booth PW, Schendel SA, Hausamen JE, eds. Maxillofacial Surgery. 1st ed. Philadelphia: Churchill Livingstone; 1999. p.1205-7.
  • 2. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993;108(2):117-25.
  • 3. Sailer HF, Haers PE, Grätz KW. The Le Fort I osteotomy as a surgical approach for removal of tumours of the midface. J Craniomaxillofac Surg. 1999;27(1):1-6.
  • 4. Kim SG, Park SS. Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg. 2007;65(12):2438-44.
  • 5. Agırnaslıgıl MO, Gul Amuk N, Kılıc E, Kutuk N, Demırbas AE, Alkan A. The changes of self-esteem, sensitivity to criticism, and social appearance anxiety in orthognathic surgery patients: A controlled study. Am J Orthod Dentofacial Orthop. 2019;155(4):482-9.e2.
  • 6. Ho MW, Boyle MA, Cooper JC, Dodd MD, Richardson D. Surgical complications of segmental Le Fort I osteotomy. Br J Oral Maxillofac Surg. 2011;49(7):562-6.
  • 7. Bowe DC, Gruber EA, McLeod NM. Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries. Br J Oral Maxillofac Surg. 2016;54(4):362-5.
  • 8. Davis CM, Gregoire CE, Steeves TW, Demsey A. Prevalence of surgical site infections following orthognathic surgery: a retrospective cohort analysis. J Oral Maxillofac Surg. 2016;74(6):1199-206.
  • 9. Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, Tuinzing DB, van't Hof MA. Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study. Int J Oral Maxillofac Surg. 1998;27(2):81-91.
  • 10. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. J Oral Maxillofac Surg. 1990;48(6):561-73.
  • 11. Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P. Perioperative complications following sagittal split osteotomy of the mandible. J Craniomaxillofac Surg. 2005;33(5):307-13.
  • 12. Steel BJ, Cope MR. Unusual and rare complications of orthognathic surgery: a literature review. J Oral Maxillofac Surg. 2012;70(7):1678-91.
  • 13. Olate S, Sigua E, Asprino L, de Moraes M. Complications in Orthognathic Surgery. J Craniofac Surg. 2018;29(2):e158-e61.
  • 14. MacIntosh RB. Experience with the sagittal osteotomy of the mandibular ramus: a 13-year review. J Maxillofac Surg. 1981;9(3):151-65.
  • 15. Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg. 2001;59(10):1128-36; discussion 1137.
  • 16. Akhtar S, Tuinzing DB. Unfavorable splits in sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(3):267-8.
  • 17. Aarabi M, Tabrizi R, Hekmat M, Shahidi S, Puzesh A. Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy. J Oral Maxillofac Surg. 2014;72(12):2508-13.
  • 18. Steenen SA, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. Int J Oral Maxillofac Surg. 2016;45(7):887-97.
  • 19. Robl MT, Farrell BB, Tucker MR. Complications in orthognathic surgery: a report of 1,000 cases. Oral Maxillofac Surg Clin North Am. 2014;26(4):599-609.
  • 20. Kramer FJ, Baethge C, Swennen G, Teltzrow T, Schulze A, Berten J, et al. Intra- and perioperative complications of the LeFort I osteotomy: a prospective evaluation of 1000 patients. J Craniofac Surg. 2004;15(6):971-7; discussion 978-9.
  • 21. Morris DE, Lo LJ, Margulis A. Pitfalls in orthognathic surgery: avoidance and management of complications. Clin Plast Surg. 2007;34(3):e17-29.
  • 22. Acebal-Bianco F, Vuylsteke PL, Mommaerts MY, De Clercq CA. Perioperative complications in corrective facial orthopedic surgery: a 5-year retrospective study. J Oral Maxillofac Surg. 2000;58(7):754-60.
  • 23. de Vries K, Devriese PP, Hovinga J, van den Akker HP. Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies. J Craniomaxillofac Surg. 1993;21(2):50-3.
  • 24. Choi BK, Goh RC, Chen PK, Chuang DC, Lo LJ, Chen YR. Facial nerve palsy after sagittal split ramus osteotomy of the mandible: mechanism and outcomes. J Oral Maxillofac Surg. 2010;68(7):1615-21.
  • 25. O'Ryan F, Schendel S. Nasal anatomy and maxillary surgery. I. Esthetic and anatomic principles. Int J Adult Orthodon Orthognath Surg. 1989;4(1):27-37.
  • 26. Chow LK, Singh B, Chiu WK, Samman N. Prevalence of postoperative complications after orthognathic surgery: a 15-year review. J Oral Maxillofac Surg. 2007;65(5):984-92.
  • 27. Little M, Langford RJ, Bhanji A, Farr D. Plate removal following orthognathic surgery. J Craniomaxillofac Surg. 2015;43(9):1705-9.
  • 28. Lanigan DT, Romanchuk K, Olson CK. Ophthalmic complications associated with orthognathic surgery. J Oral Maxillofac Surg. 1993;51(5):480- 94.
  • 29. Bendor-Samuel R, Chen YR, Chen PK. Unusual complications of the Le Fort I osteotomy. Plast Reconstr Surg. 1995;96(6):1289-96; discussion 1297.
  • 30. Kobayashi T, Izumi N, Kojima T, Sakagami N, Saito I, Saito C. Progressive condylar resorption after mandibular advancement. Br J Oral Maxillofac Surg. 2012;50(2):176-80.
  • 31. Catherine Z, Breton P, Bouletreau P. Condylar resorption after orthognathic surgery: A systematic review. Rev Stomatol Chir Maxillofac Chir Orale. 2016;117(1):3-10.
  • 32. Friscia M, Sbordone C, Petrocelli M, Vaira LA, Attanasi F, Cassandro FM, et al. Complications after orthognathic surgery: our experience on 423 cases. Oral Maxillofac Surg. 2017;21(2):171-7.
  • 33. Park SB, Yang YM, Kim YI, Cho BH, Jung YH, Hwang DS. Effect of bimaxillary surgery on adaptive condylar head remodeling: metric analysis and image interpretation using cone-beam computed tomography volume superimposition. J Oral Maxillofac Surg. 2012;70(8):1951-9.
  • 34. Patel PK, Morris DE, Gassman A. Complications of orthognathic surgery. J Craniofac Surg. 2007;18(4):975-85; Quiz 986-8.
  • 35. Al-Nawas B, Kämmerer PW, Hoffmann C, Moergel M, Koch FP, Wriedt S, et al. Influence of osteotomy procedure and surgical experience on early complications after orthognathic surgery in the mandible. J Craniomaxillofac Surg. 2014;42(5):e284-8.
APA Ulker O, Demirbas A, Kutuk N, Kilic E (2023). Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. , 15 - 21. 10.5336/dentalsci.2022-93092
Chicago Ulker Omer,Demirbas Ahmet E.,Kutuk Nukhet,Kilic Erdem Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. (2023): 15 - 21. 10.5336/dentalsci.2022-93092
MLA Ulker Omer,Demirbas Ahmet E.,Kutuk Nukhet,Kilic Erdem Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. , 2023, ss.15 - 21. 10.5336/dentalsci.2022-93092
AMA Ulker O,Demirbas A,Kutuk N,Kilic E Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. . 2023; 15 - 21. 10.5336/dentalsci.2022-93092
Vancouver Ulker O,Demirbas A,Kutuk N,Kilic E Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. . 2023; 15 - 21. 10.5336/dentalsci.2022-93092
IEEE Ulker O,Demirbas A,Kutuk N,Kilic E "Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research." , ss.15 - 21, 2023. 10.5336/dentalsci.2022-93092
ISNAD Ulker, Omer vd. "Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research". (2023), 15-21. https://doi.org/10.5336/dentalsci.2022-93092
APA Ulker O, Demirbas A, Kutuk N, Kilic E (2023). Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi, 29(1), 15 - 21. 10.5336/dentalsci.2022-93092
Chicago Ulker Omer,Demirbas Ahmet E.,Kutuk Nukhet,Kilic Erdem Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi 29, no.1 (2023): 15 - 21. 10.5336/dentalsci.2022-93092
MLA Ulker Omer,Demirbas Ahmet E.,Kutuk Nukhet,Kilic Erdem Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi, vol.29, no.1, 2023, ss.15 - 21. 10.5336/dentalsci.2022-93092
AMA Ulker O,Demirbas A,Kutuk N,Kilic E Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi. 2023; 29(1): 15 - 21. 10.5336/dentalsci.2022-93092
Vancouver Ulker O,Demirbas A,Kutuk N,Kilic E Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research. Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi. 2023; 29(1): 15 - 21. 10.5336/dentalsci.2022-93092
IEEE Ulker O,Demirbas A,Kutuk N,Kilic E "Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research." Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi, 29, ss.15 - 21, 2023. 10.5336/dentalsci.2022-93092
ISNAD Ulker, Omer vd. "Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research". Türkiye Klinikleri Diş Hekimliği Bilimleri Dergisi 29/1 (2023), 15-21. https://doi.org/10.5336/dentalsci.2022-93092