Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Causes of Ortognatic Surgery Complications and Comparison of the Literature: Retrospective Cohort Research
Ortognatik Cerrahi Komplikasyonlarının Nedenleri ve Literatür Karşılaştırılması: Retrospektif Kohort Araştırma
Ömer ÜLKERa, Ahmet Emin DEMİRBAŞb, Nükhet KÜTÜKc, Erdem KILIÇd, Alper ALKANd
aDepartment of Oral and Maxillofacial Surgery, Nevşehir Hacı Bektaş Veli University Faculty of Dentistry, Nevşehir, Türkiye
bDepartment of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Türkiye
cDepartment of Oral and Maxillofacial Surgery, Bezmiâlem Vakif University Faculty of Dentistry, İstanbul, Türkiye
dPrivate, İstanbul, Türkiye
Turkiye Klinikleri J Dental Sci. 2023;29(1):15-21
doi: 10.5336/dentalsci.2022-93092
Article Language: EN
Full Text
ABSTRACT
 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.

Keywords: Dentofacial deformity; orthognathic surgery; complications; Le Fort I; sagittal split ramus osteotomy
ÖZET
 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 Kelimeler: Dentofasiyal deformite; ortognatik cerrahi; komplikasyonlar; Le Fort I; sagittal split ramus osteotomisi
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