Morbidity related to transmandibular distraction osteogenesis for patients with developmental deformities.

INTRODUCTION: The aim of this retrospective observational case series study was to determine the morbidity of transmandibular Distraction Osteogenesis (DO) using a bone-borne distraction device to adapt the surgical protocol and improve hardware design. PATIENTS AND METHODS: The treatment of 23 consecutive, non-syndromic patients who underwent transverse mandibular DO after a midline symphyseal osteotomy with the TransMandibular Distractor (TMD ) was evaluated. The follow-up period lasted at least 1 year after the end of the contention period. Treatments were analysed according to the morphological and functional Success Criteria (SC) for Craniofacial Distraction Osteogenesis (CFDO) for patients with developmental dentofacial malformations established by the steering group of European Collaboration on Cranial Facial Anomalies (EUROCRAN). RESULTS: Appropriate distraction was obtained in 22 of the 23 patients. One patient had irreversible dentition damage, consisting of an inadvertent apical section. All other SC for CFDO were fulfilled 100% at 1 year follow-up. Seven patients suffered from short-term local infections during different phases of treatment. Two patients suffered subluxation of a central incisor that healed uneventfully. Local discomfort due to delayed union (in three patients) and trauma to the lower lip (one patient) were also observed. CONCLUSION: The main problems were high local infection rates and damage to an apex that required a root filling, as well as patient discomfort due to delayed union and/or the bulkiness of the TMD device. Based on the results of this morbidity study, modifications are recommended for both the surgical protocol and the TMD device hardware.

A prospective study on infectious complications in orthognathic surgery.

AIM: According to an earlier study in 2000, 4.7% of patients undergoing corrective facial orthopaedic surgery in this unit suffered a postoperative wound infection. In 1998, the Belgian Government recommended stricter rules for infection prophylaxis and a new antibiotic protocol similar to that proposed by Peterson (1990) was implemented in this unit. The new protocol was to be evaluated. MATERIAL AND METHODS: Eight hundred and ten consecutive patients were selected receiving orthognathic surgery (Le Fort I-type osteotomies, sagittal split osteotomies, segmental and chin osteotomies). Cefazolin 1g was administered intravenously on induction of general anaesthesia and repeated at 4h intervals for the duration of surgery. No antibiotics were administered postoperatively. The observation period was 6 weeks. When an infection occurred, appropriate culture specimens were obtained according to a standardized protocol. RESULTS: Fifty-one infections (6.8%) were diagnosed, 33 with purulent exudates occurring spontaneously or after incision and drainage. Ninety-two per cent of these infections occurred in the sagittal split area, 6% in the maxillary region and 2% in the chin region. Infections in the sagittal split area were further analysed. A reduction in infection rate from 6.6 to 2.6% was noted following a change in practice when fibrin glue was used in the wound instead of a drain in the sagittal split wound. Of the 30 aerobic cultures, 12 contained normal mucosal flora, of which 9 were Streptococcus species. In 11 of the 30 anaerobic cultures the identified species belonged to the Bacteroides group. This bacterium is resistant to cefazolin but sensitive to amoxicillin-clavulanate and for a high percentage also to clindamycin. All the other cultures were sterile. CONCLUSION: The infections occurring almost exclusively in the sagittal split osteotomy site can be partially explained by wound contamination upon removal of the drain. It is suggested that for prophylaxis cefazolin is replaced by amoxicillin-clavulanate.