Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis.

OBJECTIVES: The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. MATERIALS AND METHODS: In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0-4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. RESULTS: Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients' self-perception (85.4%), with 60.4% of patients opting for surgery again. CONCLUSIONS: Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. CLINICAL RELEVANCE: Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial.

BACKGROUND: Oral and Maxillofacial operations can be extremely frightening treatment situations. General data on this phenomenon should be acquired through a multi-centre trial. METHOD: A 10-page questionnaire was developed which was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental and general practitioners/internal medicine patients. Twenty six medical practices and hospital departments in 11 German cities were involved in the trial. RESULTS: Both subjective anxiety assessment by patients and objective testing (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment situations. Oral and Maxillofacial Surgery (OMFS) patients' scores were significantly higher than those of control groups. Especially younger and female patients, patients treated under local anaesthesia and out-patients showed intensive anxiety. Previous treatment experience in OMFS did not modify test results. CONCLUSION: Managing perioperative anxiety is still a major challenge in OMFS. Irrespective of technical, pharmacological and surgical advances, developing and establishing stress-reducing and anxiolytic perioperative techniques is of considerable importance for both patients and surgeons.

[Treatment anxiety in oral and maxillofacial surgery]. / Behandlungsangst in der Mund-, Kiefer- und Gesichtschirurgie.

BACKGROUND: Oral and maxillofacial operations are stressful treatment situations for patients. Specific data on this phenomenon were acquired through a multicenter study. MATERIAL AND METHODS: A 10-page questionnaire was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental, internal medicine and general practitioner patients. 26 practices and hospital departments in 11 German cities were involved in the study. RESULTS: Both subjective anxiety assessment by patients and objective measurement (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment. STAI scores for OMFS patients were significantly higher than in control groups. Especially female patients, patients treated under local anaesthesia and out-department patients showed high anxiety scores. Treatment experience in oral and maxillofacial surgery does not modify anxiety in case of recurrent treatment. CONCLUSION: Managing perioperative anxiety today is still a major challenge in oral and maxillofacial surgery. Irrespective of technical and pharmacological advances further studies on this topic and the development and establishing of stress-reducing and anxiolytic perioperative techniques are of considerable importance.

Rare facial clefts: treatment during charity missions in developing countries.

During 10 charity missions in developing countries, 14 patients of a total of 374 children with cleft lip and palate deformities were treated for rare facial clefts. There were three midline clefts (Tessier no. 0 cleft, n = 1; Tessier no. 14 cleft, n = 2), four oblique facial clefts (Tessier no. 3 cleft, n = 2; Tessier no. 5 cleft, n = 2), and seven lateral facial clefts (Tessier no. 7 cleft). Surgical treatment focused on cleft repair by soft-tissue reconstruction apart from two Tessier no. 14 clefts, in which the bony gap was also closed using bone grafts from the iliac crest. The postoperative course was uneventful except for one local wound infection that was treated successfully using oral antibiotics. This article summarizes the authors' experience with the surgical management of these malformations and considers the limitations under conditions of charity missions in developing countries. Furthermore, some rare forms of cleft formation are added to the existing literature.

Experimental and comparative study of the blood supply to the mandibular cortex in Göttingen minipigs and in man.

INTRODUCTION: Since the blood supply to the mandibular cortex is an important factor for bone growth and bone repair, experimental studies on the blood supply in animal models (such as Göttingen minipigs) applicable to man are necessary. Their value depends on the requirement that the patterns of blood supply in the two species are similar. MATERIAL AND METHODS: Twelve Göttingen minipig mandibles (24 halves) and four human mandibles (eight halves) were investigated for the blood supply to the mandibular cortex. RESULTS: Only minor differences were found in blood supply to the mandibular cortex between the two species. Common to both was: in the cranial part of the mandible (including the condyle), the endosteal blood supply prevailed, whereas the periosteal blood supply predominated in the caudal part of the mandible (the body). Both patterns of blood supply were in balance in the centre section, i.e. angle and ascending ramus of the mandible. CONCLUSION: The present study confirms that results obtained from Göttingen minipigs, used as an experimental animal model, are applicable to man: three different types of blood supply are evident in the mandibular cortex in both species.

Blood supply of the mandibular cortex: an experimental study in Göttingen minipigs with special reference to the condyle.

INTRODUCTION: Blood supply of the mandible is an important factor that influences bone growth and bone repair. MATERIAL AND METHODS: An experimental study was carried out in 24 mandibles of 12 Göttingen minipigs to study the blood supply of the mandibular cortex. RESULTS: Endosteal blood supply prevails in the cranial part of the mandible including the condyle, whilst periosteal blood supply predominates in the caudal part of the mandible, the body. The two forms of blood supply are in balance in the ascending ramus and the angle of the mandible. CONCLUSION: The mandibular cortex can be divided into three parts, each having different sources of blood supply. The results of this study may be of significance for man and could help to understand some pathological disorders of the mandible.