Clinical Articles
Incidence of complications and problems related to orthognathic surgery: A review of 655 patients*,**,*

https://doi.org/10.1053/joms.2001.26704Get rights and content

Abstract

Purpose: This retrospective report evaluates the incidence of pre-, intra-, and postoperative complications of orthognathic surgery and their significance to the patient. Patients and Methods: The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. Results: The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Conclusions: Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure. © 2001 American Association of Oral and Maxillofacial Surgeons

Section snippets

Patients and methods

The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The mean age of the patients at the time of operation was 30.3 years (median, 29.5 years; range, 15 to 60 years), and there were 475 females and 180 males. Most patients had had preoperative orthodontics; the few exceptions were operated on to improve their preprosthetic dentoalveolar status. The distribution of preoperative diagnoses

Preoperative phase

Symptomless resorption of the roots of the teeth was found in 22 patients. This was probably caused by orthodontics. One patient had had root resorption even before orthodontic treatment. In some patients with relapse, incorrect preoperative tilting of the posterior teeth was assumed to have caused the relapse in the presence of open bite. No other specific preoperative errors or complications could be identified.

Preoperatively, 273 patients (46%) had TMJ problems; however, the notes on 60

Discussion

The most common problem was neurosensory disturbance of the IAN, which was mild in 32% and disturbing in 3% of patients with an osteotomy in the mandible. Older patients appeared to suffer from this problem more often than younger subjects. As Westermark et al30 point out, patients should be informed of the relatively high risk of sensory disturbances, especially in view of the report43 that the occurrence of paresthesia may reduce the overall satisfaction with the outcome of treatment. As an

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    *

    Senior Oral Surgeon and Head, Oral and Maxillofacial Unit, Vaasa Central Hospital, Vaasa, Finland.

    **

    Professor and Head, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu, Finland; and Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland.

    *

    Address correspondence and reprint requests to Dr Panula: Oral and Maxillofacial Unit, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130 Vaasa, Finland; e-mail: [email protected]

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