Abstract
Orthognathic surgery (OGS) has been successfully adopted for managing a wide spectrum of skeletofacial deformities, but patients with underlying conditions have not been treated using OGS because of the relatively high risk of surgical anesthetic procedure-related complications. This study compared the OGS outcomes of patients with and without underlying high-risk conditions, which were managed using a comprehensive, multidisciplinary team-based OGS approach with condition-specific practical perioperative care guidelines. Data of surgical anesthetic outcomes (intraoperative blood loss, operative duration, need for prolonged intubation, reintubation, admission to an intensive care unit, length of hospital stay, and complications), facial esthetic outcomes (professional panel assessment), and patient-reported outcomes (FACE-Q social function, psychological well-being, and satisfaction with decision scales) of consecutive patients with underlying high-risk conditions (n = 30) treated between 2004 and 2017 were retrospectively collected. Patients without these underlying conditions (n = 30) treated during the same period were randomly selected for comparison. FACE-Q reports of 50 ethnicity-, sex-, and age-matched healthy individuals were obtained. The OGS-treated patients with and without underlying high-risk conditions differed significantly in their American Society of Anesthesiologists Physical Status (ASA-PS) classification (p < 0.05), Charlson comorbidity scores, and Elixhauser comorbidity scores. The two groups presented similar outcomes (all p > 0.05) for all assessed outcome parameters, except for intraoperative blood loss (p < 0.001; 974.3 ± 592.7 mL vs. 657.6 ± 355.0 mL). Comparisons with healthy individuals revealed no significant differences (p > 0.05). The patients with underlying high-risk conditions treated using a multidisciplinary team-based OGS approach and the patients without the conditions had similar OGS-related outcomes.
Highlights
Facial deformities associated with malocclusion cause functional and esthetic impairment and adversely affect quality of life, body image perception, self-esteem, and social interaction [1,2]
Orthognathic surgery (OGS) is a technically demanding procedure performed on facial bones, and it is associated with prolonged general anesthesia and substantial blood loss [2,3,4,5,6]
The two groups of patients had similar distributions of age, sex, and type of OGS parameters
Summary
Facial deformities associated with malocclusion cause functional and esthetic impairment and adversely affect quality of life, body image perception, self-esteem, and social interaction [1,2]. Subgroups of patients with underlying conditions or chronic underlying diseases in addition to the principal diagnosis of facial or occlusal abnormalities have not been treated using OGS because of the relatively high risk of complications. In contrast to life-saving surgical interventions, OGS is considered a life-enhancing intervention that focuses on correcting dental occlusion and improving facial esthetics and improving the quality of life and psychosocial condition of patients [1,2]. Patients with facial deformity, malocclusion, and underlying high-risk conditions can be considered potentially eligible candidates for receiving potential OGS-related benefits. This particular subset of patients may require additional care and management methods along with the conventional OGS approach. For an elective life-enhancing procedure to be considered ethically acceptable, the surgical-related risks must be weighed against its anticipated benefits, in patients affected by medical factors that may potentially increase perioperative complications [7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
