Orthognathic Surgery for Patients with Maxillofacial Deformities

Abstract

Orthognathic surgery is performed to alter the shape of the jaws to improve dental occlusion stability, improve temporomandibular joint function, open the oropharyngeal airway, and improve the patient's facial proportions. Surgery must be coordinated with orthodontic treatment. The surgeon develops a plan based on the patient's measurements and performs the planned procedure on plaster models of the patient's jaw and teeth to obtain the proper jaw position. Surgical techniques include LeFort procedures and distraction osteogenesis. Possible complications of orthognathic procedures include airway compromise, numbness, and nonunion or malunion of the bones. Postoperative instructions include an emphasis on the need for the patient to consume a blended diet for six weeks after surgery.

Educational intervention in patients undergoing orthognathic surgery: Pilot study

“…[30] Although body weight was not statistically significant between the first and last postoperative consultation, it showed a significant loss when analyzed individually comparing the weight in the preoperative period and the weight in each consultation. The same finding can be seen in other studies [12,13,31,33,34] and it is recommended that patients understand the necessity for a soft and nutritional high-calorie diet after surgery in order to maintain their body weight, thus accelerating recovery. [18,31,33] Small to medium magnitude beneficial effects of educational intervention were found in a meta-analysis conducted with small samples (less than 30) and effectiveness of educational intervention in adult surgical patients has been reconfirmed with larger samples.…”

“…The same finding can be seen in other studies [12,13,31,33,34] and it is recommended that patients understand the necessity for a soft and nutritional high-calorie diet after surgery in order to maintain their body weight, thus accelerating recovery. [18,31,33] Small to medium magnitude beneficial effects of educational intervention were found in a meta-analysis conducted with small samples (less than 30) and effectiveness of educational intervention in adult surgical patients has been reconfirmed with larger samples. [35] A study conducted in Jordan [36] assessing the perception of patients undergoing orthognathic surgery states that patients believed that preoperative information was adequate, but they suggested the use of additional materials, including brochures or videos in order to be able to assimilate incoming information.…”

Avaliação do uso de uma tecnologia educativa na educação perioperatória de cirurgia ortognática: ensaio clínico randomizado

“…A maioria deles demonstra depressão e irritabilidade após a cirurgia, devidas a presença de edema, hematomas, dor, dificuldade de se alimentar e inconveniência de manipular os elásticos do aparelho ortodôntico. Esses sentimentos são comumente referidos nos terceiro e quarto dias de pós-operatório; após o sétimo dia de pós-operatório, quando os pacientes começam a comer e manipular os elásticos com facilidade, esses sentimentos começam a melhorar 3 .…”

“…Durante o pós-operatório, a avaliação do paciente deve considerar a evolução funcional das estruturas bucais devido a edema, abertura limitada da mordida, possíveis prejuízos neurais, avaliação da sensibilidade, motricidade, controle da dor, detecção precoce das complicações e manejo dos sintomas relacionados ao pós-operatório 3,8,9 .…”

“…Por isso, é comum o uso de elásticos ortodônticos no pós-operatório para contenção oral, controle da mordida e compensação do edema pós-operatório 3 .…”