Post on 26-Oct-2014
Complications of Bimaxillary Orthognathic Surgery
Dr N.J. Rutherford
Associate Professor A.C.H. Smith
Definitions
Bimaxillary surgery involves orthognathic procedures on both the mandible and maxillaGenerally these procedures are the Le Fort I osteotomy and the Bilateral Sagittal Split osteotomyOther procedures may include genioplasty and rhinoplasty
Historical Perspective
In the last twenty years bimaxillary surgery has become accepted as a relatively safe procedurePrior to this complications were more frequent due to the following Poor instrumentation Lack of scientific studies Poor techniques Prolonged procedures Traditional methods of fixation Anaesthetic related problems
Complications
All surgical procedures have complications and morbiditiesMost complications are prevented by planning and awarenessIf you never do surgery, you never get surgical complicationsIf you do enough surgery you will have complicationsThe aim is to minimise incidence of morbidity
Complications
Systemic
Local
Preoperative
Intraoperative
Postoperative Short Term Long Term
Systemic
Cardiovascular / Renal Hypovolaemia Shock Stroke Acute Renal Failure
Respiratory Airway Compromise Aspiration Atelectasis Pneumonia
Systemic
Anaesthetic Related Anaphylaxis Malignant Hyperthermia Drug Toxicity
Pain
Psychiatric Body Dysmorphic Disorder Conversion Disorder
Local
As discussed in following slides
Balance of the orthodontic treatment objective and surgical treatment objective
Preoperative
Inadequate planningCephalometrics ImpressionsFacebow/articulatorModel surgerySurgical Wafers
Operative
Failure to achieve the surgical objectiveHaemorrhageMaxilla Devascularization Inability to mobilize maxilla Inability to reduce vertical height Unfavourable osteotomy pattern Condylar distraction Nasal septum deviation
Operative
Mandible Inappropriate split
Buccal plate fracture Lingual plate Fracture Condylar split
Inferior alveolar nerve Nerve in proximal segment Neuropraxia, Neuronometsis, Axonometsis
Facial Nerve Lingual Nerve
Operative
Mandible Inadequate external oblique ridge
reductionDamage to dental and related structures
Operative
Fixation problems Inadequate Fixation Large osteotomy gaps Inadequate bony apposition Inadequate condylar position
Soft tissue Injuries Lips, cheeks, nose
Damage to surrounding structuresImmediate relapse
Postoperative Short Term
Cardiovascular Secondary Haemorrhage Avascular Necrosis maxillary segments Haematoma formation
Infection
Bone Healing / Fixation Failed Fixation Delayed Union Mal / Nonunion
Postoperative Short Term
Early Relapse Poor fixation Unstable final postion Condylar sag Idiopathic Condylar Resorption
Extrusion of teethNeuronal Deficit Paraesthesia, anaesthesia, dysaesthesia,
hyperaesthesia
Postoperative Long Term
Relapse
Fixation Exposure / Infection
T.M.J. Pain
Neuronal Deficits
Patient Disatisfaction
Reducing Complications
Adequate Planning Listen to the patient concerns Set realistic goals for treatment Communication with orthodontist
Accuracy of preoperative work up Assessment of growth Models Articulation Model surgery
Reducing Complications
Meticulous SurgeryGood instrumentationAssistanceAdequate forceCareful dissection
Consider Autologous blood donation
Careful postoperative followup