Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery—a retrospective, cross-sectional long-term analysis

Abstract

Objectives The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. Materials and Methods In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0–4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. Results Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients’ self-perception (85.4%), with 60.4% of patients opting for surgery again. Conclusions Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. Clinical relevance Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

Risk Factors for Prolonged Mechanical Ventilation and Delayed Extubation Following Bimaxillary Orthognathic Surgery: A Single-Center Retrospective Cohort Study

“…Orthognathic surgery is a common and mostly safe procedure for correcting dentofacial deformities and malocclusions [17]. Risks of surgery include relapse of the jaw, jaw fracture, nerve injury, wound infection, or excessive blood loss, and the patient s airway may be threatened by obstruction, edema, or intraoral bleeding [18][19][20]. Kantar et al have recently shown that, compared with single-jaw surgery, double-jaw osteotomies are associated with significantly higher rates of overall complications.…”

Recovery following Orthognathic Surgery Procedures—A Pilot Study

“…Thiem et al observed that long-term difficulties after orthognathic surgery arose when they assessed intraoperative and early postoperative consequences, delayed outcomes, and patients’ average contentment, with hypoesthesia of the lower lip being an encountered side effect [ 35 ]. However, Ahmad et al described that following mandible orthognathic surgery, individuals who experienced lower lip neuropathy showed no negative effects on their comfort or quality of life [ 36 ].…”

Orthognathic Surgery in Goldenhar Syndrome With a Rare Course of the IAN

“…Although the most common complications of sagittal osteotomies and ATJR in the nondevelopmentally affected mandible are trigeminal nerve injury30,31 and facial nerve injury,32,33 respectively, those affected with hemifacial microsomia often pose a higher risk of complications. Complications include difficult or inadequate fixation, buccal or lingual plate fracture, severe bleeding, damage to IAN, facial nerve dysfunction, failed osteosynthesis, temporomandibular joint dysfunction, and skeletal relapse 34. In a patient with a hypoplastic condyle and fossa, ATJR may provide a more predictable intra-operative joint position as compared with a BSSO where the hypoplastic condyle is manually seated against a malformed, often shallow, glenoid fossa providing a less-than-reassuring stop.…”

“…Complications include difficult or inadequate fixation, buccal or lingual plate fracture, severe bleeding, damage to IAN, facial nerve dysfunction, failed osteosynthesis, temporomandibular joint dysfunction, and skeletal relapse. 34 In a patient with a hypoplastic condyle and fossa, ATJR may provide a more predictable intraoperative joint position as compared with a BSSO where the hypoplastic condyle is manually seated against a malformed, often shallow, glenoid fossa providing a less-than-reassuring stop. In this case, this was one of the challenges faced when seating the mandibular condyle, yet a repeatable axis of rotation was achieved.…”