Mandibular Orthognathic Surgery Research Articles

Condylar re-positioning devices in orthognathic surgery – is there a benefit to their use?

The bilateral sagittal split osteotomy (BSSO) is the established workhorse in mandibular orthognathic surgery. Despite the frequency at which this procedure is performed, alterations in condylar position from the surgery remain a concern to the operating surgeon. Such changes in condylar positioning have long been associated with relapse. A systematic literature review was carried out to address the question: ‘condylar re-positioning devices in orthognathic surgery – is there a benefit to their use?'. As of yet there is no robust scientific evidence to suggest that these devices confer any clinical benefit over traditional manual re-positioning in orthognathic surgery cases. It would seem appropriate that future research focus on cost effective methods for intra-operative identification of a mal-positioned condyle with the aim of preventing later relapse.

Major clinical approaches to osteotomy of the middle third face: a concise systematic review

Introduction: Orthognathic surgery is a standardized procedure used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusion, disease, or trauma. Non-ossification between the maxillary bones after osteotomies is an important complication that may occur after performing this surgical procedure. Objective: It was to evaluate and quantify the three-dimensional space between the mandibular bone segments after advances in bilateral sagittal osteotomies of the mandible, involving the middle third of the face, with a consequent indication of bone grafting to achieve better surgical results, in terms of bone healing, stability, complications and prevention of aesthetic defects. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 104 articles were found, 28 articles were evaluated and 22 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 46 studies with a high risk of bias and 20 studies that did not meet GRADE. Bilateral sagittal osteotomy involving the middle third of the face is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical, and transverse directions, with good results and few complications. Also, in orthognathic surgeries, bone grafting can accelerate bone formation.

Gingival swelling and diffuse mandibular osteolysis in a 57-year-old woman

A 57-year-old woman was referred from her hematologist for evaluation of a left mandibular gingival swelling of 1 week's duration. The hematologist expressed concern about odontogenic infection owing to the patient’s prolonged immunosuppressive chemotherapy for the management of treatment-resistant multiple myeloma (MM). The diagnosis of MM had been made in 2017, and since then she had received multiple rounds of chemotherapy, undergone autologous stem cell transplantation, and received intravenous zoledronic acid (Zometa; Novartis). Her health history was also significant for type 2 diabetes mellitus, hypertension, and a distant history of mandibular orthognathic surgery. Results of the extraoral examination did not indicate any pathology. The intraoral examination revealed a firm, sessile, nonmobile, 1-cm mass on the buccal gingiva between teeth nos. 21 and 22 (Figure 1). The results of pulpal and periapical testing of adjacent teeth were unremarkable. No evidence of purulent drainage or hemorrhage from the lesion was seen. A cone-beam computed tomographic scan revealed multiple missing teeth in the maxillary and mandibular right quadrants as well as hardware in place from a bilateral sagittal split osteotomy. In addition, multiple ill-defined radiolucencies were notable across the mandible, with cortical perforation apparent in the anterior and left mandible (Figures 2 and 3) without evidence of tooth resorption or displacement. An excisional biopsy was performed of the gingival soft-tissue lesion in the area of teeth nos. 21 and 22 under local anesthesia. The histopathologic examination revealed a gingival soft-tissue lesion composed of an unremarkable superficial squamous mucosa with extensive and diffuse submucosal infiltrates of mature plasma cells (Figure 4). Immunohistochemical staining showed that the plasma cells were positive for cluster of differentiation 138, and in situ hybridization for κ and λ light chains showed that the plasma cells were κ-restricted (Figure 5). 1 O’Connell F.P. Pinkus J.L. Pinkus G.S. CD138 (syndecan-1), a plasma cell marker: immunohistochemical profile in hematopoietic and nonhematopoietic neoplasms. Am J Clin Pathol. 2004; 121: 254-263https://doi.org/10.1309/617DWB5GNFWXHW4L Crossref PubMed Scopus (214) Google Scholar Dr. Barawi is a resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL. Mr. Shah is a student, College of Dentistry, University of Illinois at Chicago, Chicago, IL. Dr. Cabay is an associate professor of clinical pathology, Department of Pathology, College of Medicine; a clinical associate professor, Department of Otolaryngology, College of Medicine; and an associate professor, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Hospital, University of Illinois at Chicago, Chicago, IL. Dr. Callahan is an assistant professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.

Skeletal class III malocclusion and bilateral sagittal osteotomy: a concise systematic review

Introduction: In the context of skeletal class III malocclusion, orthognathic surgery is a standardized procedure used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease, or trauma. Thus, bilateral sagittal osteotomy of the mandibular ramus is a technique widely used in OS for the correction of mandibular deformities. Objective: the present study evaluated, through a concise systematic review, the main considerations of mandibular advancements through mandibular bilateral sagittal osteotomies in patients with skeletal class III malocclusion. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: A total of 115 articles were found involving “skeletal class III malocclusion". A total of 45 articles were evaluated in full, and 22 were included and discussed in this study. Bilateral sagittal osteotomy (BSO) is the most used technique in mandibular OS, allowing mandibular movements in the sagittal, vertical, and transverse directions. Several studies show good results and few complications. The size of this space is proportional to the mandibular advancement and/or rotation movements required by the patient's maxillomandibular discrepancy. The prevention of inferior mandibular edge defects is an important issue when planning an BSO traditional non-grafted BSO technique produces a large proportion of defects in the lower edge of the mandible. In cases where the advancement is greater than 10 mm and/or the patient is over 30 years old, the risk of the mandibular defect increases significantly. Also, using a bone graft in the intersegmental gap of a sagittal branch osteotomy is considered an effective clinical method to ensure the desirable intersegmental position as it helps to easily maintain the space. Conclusion: The results showed that bilateral sagittal osteotomy is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical, and transverse directions, with good results and few complications. Furthermore, a bone graft can accelerate bone formation in orthognathic surgery.

Orthognathic surgery in the mandibular advance: a systematic review

Introduction: Orthognathic surgery is a standardized procedure used to improve a patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease or trauma. Bilateral sagittal osteotomy of the mandibular ramus is a technique widely used in orthognathic surgery to correct mandibular deformities. Mandibular advancement is a procedure with a high risk of skeletal recurrence, due to the difference between the proximal and distal bone segments. Objective: To carry out a systematic review of orthognathic surgery in the mandibular advance, focusing on the main challenges and importance. Methods: The present study was followed by a systematic literature review model - PRISMA rules. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Bilateral sagittal osteotomy is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical and transverse directions, with good results and few complications. However, this technique can cause mandibular advancements above 10 mm, strongly pointing to the placement of a bone graft in order to avoid defects and their complications. Therefore, in orthognathic surgery, bone grafting can accelerate bone formation.

Improved lip esthetics in patients with skeletal Class III malocclusion and facial asymmetry after isolated mandibular orthognathic surgery

Asymmetry of the lips severely affects facial esthetics and is often one of the chief complaints of orthognathic patients, especially those with Class III malocclusion. The objectives of this study were to investigate the changes in lip symmetry in patients with mandibular prognathism and deviation and the relationships between jaw hard tissue and lip soft-tissue changes. Three-dimensional facial scan and cone-beam computed tomography scan data of 30 orthodontic-orthognathic patients treated with bilateral sagittal split ramus osteotomy were combined to conduct the research. Paired-sample t test and Pearson correlation coefficient were applied to compare the differences in the same variable before and after the orthognathic surgery and the potential correlations between the changes in hard and soft variables. To explore the important hard tissue variables influencing the lip soft-tissue changes, linear regression analysis was performed. Although there was significant upper lip asymmetry presurgery, the upper lip asymmetry was corrected postsurgery. Surgical correction of the mandibular deviation was also accompanied by lengthening of the bilateral philtrum crests. Improvement in lip asymmetry and lengthening of the philtrum crests were primarily related to the transverse correction of the mandible rather than sagittal changes. The corresponding prediction formulas were established. The isolated mandibular bilateral sagittal split ramus osteotomy surgery can substantially improve the upper and lower lip asymmetry in patients with mandibular prognathism and deviation, but one should be wary of the unesthetic effects associated with lengthening of the philtrum crests.

Clinical outcome assessment of surgery first orthodontics after approach for skeletal malocclusions: A pilot study

Background: To investigate treatment outcome of skeletal malocclusion managed employing SFOA. Material and Methods: The study sample (n=10) requiring mandibular orthognathic surgery was categorised as Group 1 (GP 1) – Skeletal Class II & Group 2 (GP 2) – Skeletal Class III. Pre (T0) and post (T1) treatment records were analyzed using the CCA Index to assess the clinical outcome of the treatment. Lateral cephalogram was analyzed using WITS Appraisal and McNamara analysis to quantify treatment changes. The total duration of treatment was recorded from the case records of patients. Pain perceived by the patients was assessed using Visual Analogue Scale (VAS) after 03 days of surgical procedure, 03 weeks and 03 months. Results: Mean change in SNB angle was significantly higher in Group 2 compared to Group 1 (P value<0.05). The mean change in ANB angle was significantly higher in Group 1 compared to Group 2 (P value<0.05). The mean change in facial aesthetics score and dental aesthetics score did not differ significantly between two study groups (P value>0.05). For both groups, mean pain response on 3rd day post-surgery was moderate to severe on the VAS which improved to mild to moderate by 3rd week and after 3 months majority of the patients had no pain. The mean total treatment duration from surgery to orthodontic finishing and detailing was 12.2 months, with a range of 8.4 months to 14.6 months. Conclusions: SFOA results in an immediate and marked improvement in skeletal component of the malocclusion along with significantly improved facial and dental aesthetics.

Partial Bone Necrosis Following Sagittal Split Ramus Osteotomy: Report of a Complicated Orthognathic Jaw Surgery

Study Design Case Report. Objective To present a case of a previous complicated mandibular orthognathic surgery that aimed to setback the mandible in a female cleft lip and palate (CLP) patient, which led to bone necrosis on one side with subsequent severe mandibular deviation and facial asymmetry. We additionally reviewed the previous reports of similar complications, the pathophysiology and the factors that could lead to this dreadful result. Method A 27-year-old female patient presented with a severe dentofacial deformity secondary to a complicated bilateral sagittal split ramus osteotomy performed five years earlier, which resulted in aseptic bone necrosis on the right side. The patient had marked mandibular deviation, chin and midface retrusion and a pronounced occlusal discrepancy. Imaging demonstrated a bony defect at the right mandibular angle with a superiorly displaced proximal segment. Deviation of the mandible was corrected first by performing vertical ramus subsigmoid osteotomy (RSO) on the left side. The right bone defect was then reconstructed with a reconstruction plate and bone grafting. Maxillary and chin advancement was performed at a second stage. Results On follow-up, the patient shows a significant improvement in facial esthetics and mandibular symmetry and is currently under orthodontic management to enhance the occlusal relationship. Conclusion Bone necrosis is a rare but dreaded problem in orthognathic surgery. Minimizing the musculo-periosteal dissection and competent execution of the bone osteotomy is substantially effective in reducing the risk of bone ischemia and necrosis.

The Use of Computer-Guided Half Propeller Genioplasty for the Correction of Mandibular Asymmetry (A Mandibular Orthognathic Surgery Without a Condylar Intervention Technical Strategy).

Mandibular asymmetry is a facial deformity that results from multiple causes; among these are growth deficiency like hemifacial microsomia and growth excess as in condylar hyperplasia. The facial asymmetry caused by condylar hyperplasia has been treated over the years with different surgical and nonsur-gical modalities dependent on the age of the patient and the severity of the condition. The authors in this article introduce a modified version of the propeller genioplasty technique. A new surgical technique "modified propeller genioplasty" is introduced for the management of facial asymmetry. Virtual surgical planning of the osteotomies and segment repositioning was done virtually. A cutting guide, positioning guides and 3D model of the corrected chin were 3D printed, to facilitate replication ofthe virtually planned osteotomies, prebending of plates, and segment repositioning. The esthetically accepted result was achieved using this technique with minimal postoperative complications. The technique appeared to be accurate, simple, and more cost efficient when compared to patient-specific plates.

Is There a Difference in Postsurgical Complications between Alloplastic and Allogeneic Bone Grafting following Le Fort I Osteotomy?

Statement of the problemWidening, advancing, and/or inferiorly repositioning the maxilla during Le Fort I osteotomy provides challenges to the surgeon secondary to interpositional bony gaps created across the osteotomy. Although several studies investigate the use of autogenous and non-autogenous bone graft materials to help overcome such challenges, there is a scarcity in the literature regarding the use of allogeneic bone as a bone graft substitute. The aim of the present study is to evaluate differences in postsurgical complications following use of allogeneic and alloplastic bone graft substitutes during Le Fort I osteotomy. Materials and methodsThis retrospective study involved analysis of electronic medial records of all patients who underwent Le Fort I osteotomy with internal rigid fixation and grafting over an 8-year period. A total of 233 records were reviewed, and subjects grafted with exclusively autogenous bone graft, grafted with multiple bone substitute types, or with less than 6 months follow-up were excluded. The study sample included 97 patients who were divided into 2 groups based on the bone graft material used; Group 1: porous block hydroxyapatite (PBHA); and Group 2: allogeneic iliac tricortical bone. Incidence of graft dehiscence, surgical site infection, and non-union was recorded for each group. Method of data analysisA Chi-square test of independence was performed to examine the relation between bone graft substitute and incidence of postsurgical complications. A P-value of less than .05 was considered statistically significant. ResultsThe patients’ mean age at surgery in Group 1 was 20 years and in Group 2 was 29 years. Average follow-up in each group was 9 months. The overall incidence of postsurgical complications was 9.97%, and 11.76% in Group 1 and 7.94% in Group 2. There were no statistically significant differences in postsurgical complications between Group 1 and Group 2 . Patients younger than 37 years of age had fewer postsurgical complications (5.56%) when compared to those over the age of 37 years (20.00%) (P < .05). Patients with concomitant mandibular orthognathic surgery had lower graft healing complication incidence (6.98%) as compared to isolated Le Fort I osteotomy patients (27.27%) (P < .05). ConclusionBoth bone graft materials have comparable graft-related complication rates in Le Fort I osteotomies. Incidence of complications is lesser in younger patients and those undergoing concomitant mandibular orthognathic surgery. The need for autogenous bone grafting in maxillary surgery could be questioned based on the results of this study.

Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial

The objective of this triple-blind, randomized, placebo-controlled trial was to assess the clinical analgesic efficacy of 0.5% bupivacaine in acute postoperative pain management after bilateral sagittal split ramus osteotomy (BSSO). Patients were randomly allocated into the experimental (0.5% bupivacaine with 1:200000 epinephrine) or control group (normal saline - placebo) using block randomization. The interventions were administered at the inferior alveolar nerve block and buccal nerve block sites bilaterally after the BSSO surgery. Analgesic efficacy was assessed in terms of the patient's pain perception measured by a numerical rating scale (0 to 10), rescue drug requirement, and duration of analgesia for 24 hours after the surgery. The statistical analysis was blinded to the allocation groups, and P-value of <.05 was considered as a significant difference for all tests. In total, 28 patients underwent BSSO (ie, 14 in each group). There was no significant difference in pain perception of patients injected with 0.5% bupivacaine and those administered with placebo during the 24 hours after the surgery (P > .05). Three patients in the bupivacaine group took the rescue drug after the surgery (mean duration - 268 minutes) and 1 patient in the placebo group took the rescue drug after 27 minutes. Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.

Quality and outcomes in orthognathic surgery, oral and maxillofacial surgery department at Oxford University Hospitals

Introduction/aims: Outcomes measures following orthognathic surgery have historically been based on PROM using patient satisfaction questionnaires. Following the recent emphasis on improving quality and outcome measures in OMFS, we were encouraged to assess how our practice compares to any national data. A national review of mandibular orthognathic surgery activity in the NHS in England over a nine-year period showed that the mean inpatient stay was 3.2 days and is gradually reducing. We aimed to compare our average stay to the national average and assess if we were experiencing a higher number of readmissions/RTT compared to national average.

Mandibular orthognathic surgery does not alter temporomandibular joint symptoms – A single centre prospective study

AbstractAimMandibular orthognathic surgery has been considered a risk factor for developing temporomandibular dysfunction (TMD). A prospective follow‐up study was initiated to examine the correlation between two surgical techniques for mandibular advancement and setback on mandibular range of movement and temporomandibular joint symptoms.Materials and methodsThirty‐four patients who underwent mandibular orthognathic surgery were included. Twenty patients were operated with the intraoral vertical ramus osteotomy (IVRO) technique and subsequent rigid maxillomandibular fixation (MMF) for 6 weeks; 14 were operated with the bilateral sagittal split osteotomy (BSSO) with internal osteosynthesis. The patients completed a questionnaire regarding subjective symptoms and were examined 1 day before, and 1 year after surgery. Evaluations of tenderness upon muscular and articular palpation, assessment of mandibular mobility and calculation of the Helkimo index were performed.ResultsMean maximum mouth opening was reduced one year after surgery for both experimental groups. The BSSO‐group also experienced reduced laterotrusive and protrusive movements. No statistically significant differences within or between the groups were found for the Helkimo clinical dysfunction score. Both groups reported no differences in TMD‐related symptoms before and after surgery, and no differences were found between the groups.ConclusionsMaximum mandibular movement was slightly reduced for both surgical techniques. Assisted mouth opening, laterotrusive and protrusive mandibular movements were reduced after BSSO, and maximum mouth opening was reduced after IVRO. However, the differences were small and both groups were well within the normal range. None of the groups experienced changes in TMD‐related symptoms.

Quantifying Upper Airway Changes Following Mandibular Orthognathic Surgery.

The aim of this study was to quantify upper airway changes following mandibular orthognathic surgery. Treatment records of 50 patients who underwent mandibular orthognathic surgery were divided into 2 groups, that is, Group 1: Cases treated with Mandibular Advancement Surgery and Group 2: Cases treated with Mandibular Setback Surgery with 25 patients in each group. The Lateral Cephalogram and Acoustic Pharyngometry records of both groups were studied at T0 (01 week before surgery) and T1 (01 year postsurgery) for changes in linear airway measurements (Nasopharyngeal Airway Space - NAS, Superior Airway Space - SAS, Posterior Airway Space - PAS and Hypopharyngeal Airway Space (HAS)), hyoid bone position (Mandibular Plane Hyoid distance), mean area and mean volume. The percentage change and change in these parameters per millimeter advancement or setback of mandible at T1 was calculated. A significant increase in linear airway parameters (SAS and PAS); decrease in hyoid distance; and increase in volume and area of upper airway was observed at T1 in Group 1 and reverse was observed in Group 2. The change in airway parameters (SAS, PAS, mean volume and area) was more significant in Group 1 as compared to Group 2. In the current airway centric approach, meticulous assessment and prediction of long-term airway changes post surgery should be an integral part of ortho-surgical diagnosis and treatment planning and suitable modifications in the treatment plan must be made to cater for any potential adverse effects on airway.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Relapse is a continuing process and should be evaluated on a long rather than short term. Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01week before surgery), T1 (01week after surgery), T2 (01year after surgery) and T3 (minimum 05years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Observation on the Analgesic Effect of Bilateral Inferior Alveolar Nerve Block Combined With Parecoxib Sodium for Mandibular Orthognathic Surgery

Background: To compare the analgesic effect and safety of bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump in analgesia after orthognathic surgery. Methods: Forty patients with simple ascending sagittal split osteotomy and ankle plasty were randomly divided into the experimental group and the control group, with 20 patients in each group. The experimental group received 2 ml 1% on both sides. Ropivacaine was treated with inferior alveolar nerve block anesthesia. Immediately after surgery, parecoxib sodium 40 mg was intravenously administered. The control group was given an intravenous analgesia pump for analgesia. Pain intensity (VAS pain score) and Ramsay sedation score were recorded at 2h, 4h, 8h, 24h, 48h after operation, and the incidence of postoperative adverse reactions was observed. Results: There was no significant difference in pain intensity and Ramsay sedation score between the two groups at each time point (P&gt;0.05). During the analgesic treatment, the incidence of nausea and vomiting (P=0.046) in the experimental group was significantly lower than that in the control group (P&lt;0.05). Conclusion: Bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump are effective for analgesia after mandibular orthognathic surgery, but the incidence of adverse reactions is significantly lower, more suitable for Analgesia after mandibular orthognathic surgery.

Photobiomodulation as oedema adjuvant in post-orthognathic surgery patients: A randomized clinical trial

Photobiomodulation therapy (PBMT) has been used in multiple applications in general medicine as powerful anti-inflammatory, analgesic and reducing oedema in different parts of the body. The aim of this study is to compare the effect on post-surgical oedema after mandibular orthognathic surgery, between two different laser power densities and oral medication with non-steroidal anti-inflammatory. In a randomized clinical trial, on 60 patients who were subject to mandibular orthognathic surgery were divided into three groups. All groups received sodium naproxen 250mg every 8hours for 6days. Two groups were irradiated with two different laser application protocols and the other was a control group. In G1 group the irradiation parameters three times per week for two weeks were: 940nm, in continuous mode, 2.5W, 120s, 85.71J/cm2, 0.89W/cm2, over the right and left side with a distance from the skin surface of 1mm with the whitening handpiece (spot size of 2.8cm2). In G2, the irradiation parameters three times a week for two weeks were: 940nm, in continuous mode, 4.1W, 120s, 68.33J/cm2, 0.58W/cm2 over the right and left side with a distance from the skin surface of 15mm, with the deep tissue handpiece (spot size of 7.1cm2). In all the groups, millimetric facial measurements were taken from tragus to lateral commissure, and from lateral commissure to gonion in both sides. All differences between T1 and T6 were significant for the three groups, (paired T, P<0.05). The differences between the groups were generally not significant (P>0.05) except for commissure-right and left gonion when compared G1 vs CG (P<0.05) and G2 vs CG (P<0.05). Initial changes (T1-T2) between groups were significantly different except for the measurement from commissure to right tragus G1 vs CG (P=0.411) and from commissure to left tragus G2 vs CG (P=0.94). The faster resolution of the oedema occurred in G2 group. PTBM with an energy density of 68.33J/cm2 was the most effective adjuvant to oral medication with non-steroidal anti-inflammatory, to decrease post-surgical oedema after mandibular orthognathic surgery.

Reduction of Postoperative Narcotic Usage Following Mandibular Orthognathic Surgeries: Is Exparel an Effective Agent?

Exparel, a liposomal bupivacaine designed to expand anesthetic duration of action, has been suggested as a possible solution to fight against the opioid epidemic in the United States1-2. Due to the significant abuse potential of opioids and the high amount of narcotics prescribed after orthognathic surgery, our goal was to determine if the quantity of opioids used after orthognathic surgery can be decreased. The purpose of this study is to investigate if the use of liposomal bupivacaine in mandibular orthognathic surgery will lessen the amount of opioids used in the postoperative setting. Objectives will include quantifying the amount of opioids used in a retrospective and prospective cohort and compare this to a prospective cohort that the liposomal bupivacaine is used in.

Neurosensory Deficit of Inferior Alveolar Nerve Following Mandibular Orthognathic Surgery.

Neurosensory Deficit of Inferior Alveolar Nerve Following Mandibular Orthognathic Surgery.

Reduction of postoperative narcotic usage following mandibular orthognathic surgery: efficacy of liposomal bupivicaine examine

Reduction of postoperative narcotic usage following mandibular orthognathic surgery: efficacy of liposomal bupivicaine examine