Orthognathic Surgical Patients Research Articles

Associations between temporomandibular disorders, pain, jaw and masticatory function in dentofacial deformity patients: A cross-sectional study.

Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw and masticatory function at different stages of orthognathic surgical (OS) treatment. A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-coloured chewing gum. Data were analysed using structural equation modelling. The prevalence of non-painful TMD did not differ between groups (p = .827). However, the prevalence of painful TMD differed between groups (p = .001). Among the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (p = .031), and importantly group 4 did not differ from group 0 (p = .948). The MPQ score was significantly higher in group 1 (p = .001) compared to group 0, and the JFLS score was significantly higher in groups 1, 2 and 3 compared to group 0. Notably, MPQ (p = .756) and JFLS (p = .572) scores in group 4 were not different from group 0. However, MVBF (p = .996) and ME (p = .991) did not differ between groups 1 and 4. The association of self-reported pain and jaw function with the masticatory function was observed in OS patients. OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. The masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners.

This retrospective two-centre study aimed to evaluate the occlusal outcomes in patients undergoing orthognathic surgery with clear aligners. A retrospective chart review and occlusal outcomes for 15 patients (10 females and five males) with different types of dentofacial deformities in the anteroposterior, vertical and transverse dimensions, who underwent orthognathic surgery in conjunction with clear aligners were evaluated. Weighed Peer Assessment Rating (PAR) index scores of the pre-treatment and post-treatment digital models were used to assess initial complexity, final occlusal outcomes and degree of improvement with surgery and clear aligners. The mean post-treatment PAR score was 3.5± 2.54, which was a statistically significant improvement from the pre-treatment PAR score of 27.63 ± 12.09, an 87% improvement was achieved. All subcategories of the PAR index showed statistically significant improvement except for midline assessment component. Occlusal outcomes with aligners showed great improvement as indicated with the PAR index scores. Orthognathic surgical cases can be treated efficiently with aligners and future studies should compare occlusal outcomes between orthognathic surgical patients treated with clear aligners and those treated with fixed appliances.

A Guide to Orthodontic Devices for Trainees in Orthognathic Surgery

Purpose: Despite the interplay between orthodontics and orthognathic surgery, trainees in plastic surgery and oral and maxillofacial surgery do not receive formal training in orthodontics and associated hardware. This study aims to help surgical trainees better understand the role of orthodontic treatment in achieving enhanced dental occlusion and alignment and optimize surgical decision making. Methods: A review of recent literature was conducted to consolidate current practices for the use of orthodontic devices commonly used in orthognathic surgical patients. Results: Orthodontic treatments may be preventive, interceptive, and/or corrective. Braces and clear aligners are popular devices used to correct tooth positioning via 3 orders of control: first (“in-out” and rotation), second (mesio-distal angulation or “tip”), and third order (inclination or torque). Further, various treatments exist for skeletal and dental malocclusions, which may occur in transverse (crossbites, narrow arches) and/or sagittal (over/underbites) planes. Palatal expanders such as the Hyrax or Haas assist in correction of transverse deficiencies. Appliances for sagittal corrections typically take advantage of patient’s remaining growth and include a variety of headgear types (cervical, high-pull, occipital, reverse-pull), functional appliances (fixed or removable), or simply the use of interdental elastics. Conclusion: As patients are increasingly seeking orthodontic care in conjunction with surgery, it is important for surgical trainees to develop a strong understanding of the various orthodontic devices used.

Considerations for treatment of patients undergoing orthognathic surgery using clear aligners

• Digital processes for treatment planning, and appliance fabrication, make the use of clear aligners to treat orthognathic surgery patients more feasible. • Suggestions for the systematic treatment of orthognathic surgery patients with clear aligners are reviewed. Clear aligners are an established modality for the treatment of mild-moderate orthodontic malocclusions. However, special considerations, or further adjuncts to treatment, may be necessary when treating challenging discrepancies with clear aligners. One such example is the treatment of patients undergoing orthognathic surgery to resolve dentofacial deformities. As with fixed appliances, treatment of orthognathic surgical patients using clear aligners involves very specific considerations for successful treatment planning, presurgical preparation, and postsurgical finishing and detailing. By suggesting protocols for treatment and precautions to consider, the author desires to provide the clinician with another possibility for treating this group of patients outside of fixed appliances only.

A Comprehensive Single-Center Analysis of Postoperative Nausea and Vomiting Following Orthognathic Surgery.

Postoperative nausea and vomiting (PONV) remains a major clinical end-point for directing enhanced recovery after surgery (ERAS) protocols in facial plastic surgery. This study aimed to identify risk factors for PONV and evaluate strategies for PONV reduction in orthognathic surgery patients. A retrospective cohort study was performed among patients receiving orthognathic surgery at our institution from 2011 to 2018. Patient demographics, surgical operative and anesthesia notes, medications, and nausea/vomiting were assessed for each patient. The amount of opioid analgesia given both perioperatively and postoperatively was recorded and converted into morphine equivalents (MEQ). Stepwise regression analysis was used to identify significant risk factors for PONV. Post hoc analyses were employed to compare PONV among patients based on MEQ dosage and antiemetic prophylaxis regimes. A total of 492 patients were included; mean age was 23.0 years (range: 13-60); 54.4% were female. The majority of patients received concurrent Le Fort I osteotomy, BSSO, and genioplasty (70.1%). During hospitalization, 59.4% of patients experienced nausea requiring antiemetic medications and 28.4% experienced emesis. Stepwise regression yielded Apfel scores (P = 0.003) and postoperative opioids (P = 0.013) as the strongest predictors of PONV. Post hoc analyses showed that undertreatment with prophylactic antiemetics (based on Apfel) predicted increased PONV (+12.9%, P = 0.020), and that lower postoperative MEQs (<28.0) predicted decreased PONV (-11.8%, P = 0.01). The study findings confirm the high incidence of PONV among orthognathic surgical patients and stratify previously reported PONV risk factors. More aggressive utilization of antiemetic medications and decreased dependence on opioid analgesia may decrease nausea/vomiting following orthognathic surgery.

Accuracy and reliability of voxel-based dentoalveolar registration (VDAR) in orthognathic surgical patients: a pilot study with two years’ follow-up

The purpose of this study was to validate the applicability of using maxillary voxel-based dentoalveolar registration (VDAR) at long-term follow up in orthognathic surgical patients. A retrospective sample of 25 patients (skeletal class II or III) who underwent bimaxillary orthognathic surgery was recruited and divided into two groups. Group A included 15 patients (seven females, eight males, mean (SD) age 25.8 (14.4) years) with unrestored dentition and group B involved 10 patients (five females, five males, mean (SD) age: 26.2 (11.9) years) with dental restorative treatment. Postoperative cone-beam computed tomography (CBCT) scans were acquired at four time-points, one to six weeks (T1), six months (T2), one year (T3) and two years (T4). Voxel- based registration was applied using the cranial base and then complete dental segment with part of the alveolar bone at T1-T2, T1-T3 and T1-T4 time-intervals. The translational and rotational accuracy and reproducibility of the registered maxillary segment was evaluated at these three intervals by analysing the transformation matrix using singular value decomposition. All translational and rotational measurements showed excellent reliability in both groups without any significant difference. The combined translational and rotational difference was found to be within the clinically acceptable range of 2mm and 4°. The VDAR was found to be accurate and reliable to be utilised for a long-term skeletal follow-up in orthognathic surgical patients.

Transportation degrades the quality of plaster cast models in virtual surgical planning -Is it time for direct intraoral scanning?

The plaster cast model (PCM) needs to precisely reproduce the patient’s dentition to ensure optimal fit of the surgical splint; However, transporting physical models entails a risk of fracture of cusps, brackets or entire models. This study evaluated whether clinically significant differences (&gt;1 mm) exist between the patient’s dentition and the PCM, and whether additional fractures occur from transportation from Odense, Denmark, to Rockhill, USA. This prospective study enrolled 10 orthognathic surgical patients. Three digital models were produced per patient: A direct intraoral scan, a scan of the PCM in Odense, Denmark, and a scan of the PCM at 3D Systems, Rockhill, USA. Primary outcome was distance between 2 sets of digital models. Primary predictor was transportation. The study found only 2 patients with no differences above 1 mm. Fractures occurred more often on brackets compared with teeth (Odds ratio: 5.4; P &lt; .001). Fractures of brackets occurred twice as often on maxillary models (P = .045). Fractures occurred equally often during the 2 transportations. In conclusion, surgical splints produced from PCM could incorporate inaccuracies primarily related to the orthodontic appliances. Therefore, it is recommended to minimize model transportation before digitization and preferably use intraoral scanning to minimize errors. Key words: Orthognathic surgery, Surgical splints, dental models, digital occlusion, intraoral scanner, plaster cast model.

Residents' journal review

Residents' journal review

Rural and urban differences in orthognathic surgical patients in the north east of Scotland

We have previously identified differences in the presentation and treatment of cancer between patients who live in rural compared with urban areas, but have not yet seen differences in those treated by orthognathic surgery. We hypothesised that patients from areas further away from the hospital face higher costs to attend and may not present with minor problems as often as those who live nearby. We therefore retrospectively reviewed all those (n=216) who had presented for orthognathic surgery over a six-year period (May 2011 to May 2017). The severity of malocclusion and facial asymmetry was established by combining measurements of intraoperative movements. Rurality was measured as the distance from home to the hospital at the time of operation. Those with smaller intraoperative movements (less than 7mm combined movement) lived significantly closer to the hospital as the crow flies (mean difference 15.13 miles, 95% CI 0.20 to 30.48, p=0.05) and could travel there more quickly (mean difference 65minutes 95% CI 9.8 to 121.7, p=0.02) than those with larger movements. Our results suggest that patients with small malocclusions and slight facial asymmetry who live further away from the hospital, may be less likely to present for operation than those who live closer. We explain why socioeconomic class is unlikely to confound our results, and suggest potential ways to minimise the effect observed.

Patient-Specific Printed Plates Improve Surgical Accuracy In Vitro

It remains unclear to what extent patient-specific printed plates can improve surgical outcomes in orthognathic procedures. This study aimed to quantify the surgical accuracy of patient-specific printed plates invitro and to compare the results with patients' actual surgical outcomes. This invitro study enrolled 20 postoperative orthognathic surgical patients, all treated with inferior maxillary repositioning. The preoperative midfaces were re-created in a 3-dimensionally printed model. The osteotomy and screw holes were placed at prespecified positions using a 3-dimensional guide. The dental segment was repositioned by means of the patient-specific plates. The primary outcome was the mean reposition at 3 dental reference points. The primary predictor variable was the obtained surgical reposition invitro compared with the virtual surgical plan. Confounding variables were gender, age, occlusion, and bimaxillary surgery. The secondary outcome was surgical accuracy, and the secondary predictor was the invitro outcomes versus the patients' surgical outcomes. Surgical accuracy was defined as the difference between the obtained reposition and the virtual surgical plan on a continuous scale. The differences were recorded in 3 dimensions according to the positive valueof the 3 axes: right, anterior, and posterior. The results were analyzed using mixed-model regression and 1-sample t tests. In the 20 patients (age, 18 to 64years; 40% of patients were women), the mean planned reposition was 2.9mm anterior and 1.8mm inferior. In all models, the osteotomy edge was rounded off to position the plate in the predetermined position. Overall, the maxilla was positioned 0.5mm anterior and 0.3mm inferior to the planned position using patient-specific plates. The patient-specific plates positioned the maxilla in close approximation to the planned position without surgically relevant differences. The osteotomy edge must be carefully inspected for interference with the patient-specific plates to avoid displacement of the planned maxillary repositioning.

Is it justifiable to admit Orthognathic surgical patients for less than 23 hours? A single surgeon's experience

Introduction: To assess how long, on average orthognathic patients are admitted to a ward following their surgery and to investigate if there were any immediate re-admissions or complications after discharging these patients.

A Standardized Preoperative Group Intervention Is Feasible and Acceptable to Orthognathic Surgery Patients

Nearly 10% of patients remain dissatisfied after orthognathic surgery, largely because of psychoeducational or psychosocial factors. The purpose of this study was to evaluate the feasibility and acceptability of a psychoeducationally based group intervention to improve preoperative preparation of orthognathic surgical patients and their caregivers. The intervention consisted of 2 group sessions, with each session lasting 2hours. The sessions provided realistic expectations of the surgery, offered teaching strategies for coping with pre- and postoperative symptoms of psychopathology, and highlighted the importance of social support. Feasibility was based on attendance, homework completion, and data collection rates, and acceptability was based on post-treatment participant satisfaction scores on the Client Satisfaction Questionnaire-8 (CSQ-8) and credibility and expectancy scores on 2 subscales of the Credibility/Expectancy Questionnaire-Modified (CEQ-M). Twenty-six orthognathic surgical patients were recruited from an outpatient oral and maxillofacial surgery clinic to attend the group-based intervention. Seventy percent of patients who attended at least 1 session completed the 2 sessions, and 64% of those who attended the 2 sessions completed at least 1 homework assignment. The authors successfully collected 84% of the total measures given to patients and their caregivers. The mean satisfaction rating of the patients was 30.12 of 32 (CSQ-8; n=13; standard deviation [SD], 2.33), the mean credibility rating of the patients and their caregivers was 25.2 of 27 (CEQ-M; n=20; SD, 1.85), and the mean expectancy rating of the patients and their caregivers was 20.54 of 27 (CEQ-M; n=20; SD, 4.39). The psychoeducationally based group intervention was feasible and acceptable for participants and their caregivers. This article offers suggestions to further improve the feasibility and acceptability of the intervention, including optimizing standardization of data collection procedures, decreasing barriers to access, and increasing participant engagement.

Self-reported temporomandibular disorder symptoms and severity of malocclusion in prospective orthognathic-surgical patients

Objective: The objective of this study is to analyze the association between self-reported symptoms of temporomandibular joint disorder (TMD) and the severity of malocclusion in prospective orthognathic-surgical patients.Material and methods: The subjects consisted of 50 consecutive patients (13 males and 37 females) referred to two university clinics for assessment of orthodontic-surgical treatment need. Data considering self-reported TMD symptoms were gathered using a semi-structured diary. At the first appointment, all patients rated the importance of treatment (on a scale of 1–10) and assessed self-perceived dental appearance using a VAS scale. The scale was anchored with photographs 1 and 10 from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Study models were assessed by an experienced orthodontic specialist using the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON). Association between the PAR and ICON scores and the number of reported symptoms was analyzed statistically.Results: Seventy-one percent of patients reported experiencing TMD symptoms. The most prevalent symptoms were pain in the head and/or neck region and fatigue in the TMJ region. The number of symptoms was highest in the morning. Ninety percent of males and 86% of females rated the importance of treatment as high; males experiencing TMD symptoms tended to rate surgery as more important compared with males with no symptoms (p = 0.056).Conclusions: In this sample, the results cannot unambiguously confirm an association between self-reported symptoms of TMD and objectively defined severity of malocclusion.

Does Practice Type Determine the Complexity of Patients Encountered for Orthognathic Surgery?

This study sought to determine whether the type of oral and maxillofacial surgery (OMS) practice dictated the complexity of patients encountered for orthognathic surgery and to determine whether there were meaningful differences in comorbidities between patient groups. This was a retrospective cohort study of orthognathic surgical patients operated on by surgeons at an academic medical center (AMC; OMS department at the University of Alabama-Birmingham) compared with a private practice (PP) group that also operated at the AMC auxiliary facility. Surgical procedures included in this study were Le Fort osteotomy, bilateral sagittal split osteotomy, genioplasty, and combinations of these procedures. An experienced surgeon scrutinized the medical records of the AMC and PP groups for age, gender, medical history, American Society of Anesthesiologists (ASA) classification, and indications for surgical procedures. These data were statistically compared for differences in patient complexity. The average age of patients in the 2 groups was similar (AMC, 29yr; PP, 27yr). Many more females were treated in the PP setting (male-to-female ratio, 1.06:1 in the AMC group and 1:1.6 in the PP group). The AMC group had a larger percentage of patients with medical comorbidities, a larger proportion of patients with ASA class 2 or 3, and a larger proportion of patients who underwent procedures for reasons other than malocclusion or cosmetic purposes, and these proportions were statistically relevant. Average length of surgery and average length of stay were longer in the AMC group. This retrospective cohort study suggests that OMS departments in AMCs tend to treat orthognathic surgical patients with increased comorbidities and systemic illnesses and operate on a larger percentage of patients with concomitant dentofacial issues versus more routine dentofacial skeletal and occlusion deformities.

Orthodontic considerations in orthognathic surgery: Who does what, when, where and how?

Surgical orthodontics to correct severe malocclusions and skeletal deformities involves a considerable amount of treatment planning and coordination with a multidisciplinary team. The success of the surgery requires an excellent collaboration between the orthodontist and the surgeon primarily, and secondarily with other specialties that may be involved during the diagnostic, treatment, and posttreatment phases. There is a recent movement into the surgery-first approach, which eliminates esthetically undesirable facial changes due to decompensation of the teeth from the presurgical orthodontic preparation. For both the conventional and surgery-first approaches, careful and detailed creation of a treatment plan is crucial to produce the most accurate, esthetic, and functional results. Advanced development and application of cone-beam computed tomography with three-dimensional models, craniofacial morphology and growth studies, and virtual orthodontic and surgical treatment planning are changing the traditional way that orthognathic surgery is being performed. This article discusses the interaction between orthodontists and surgeons concerning orthognathic surgical patients to improve communication between both the specialties.

Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature

This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). Patients with CMs or CMDs often have characteristic dentofacial malocclusions that contribute to functional problems with feeding and drooling and psychosocial problems. Orthognathic surgery, usually bimaxillary, can be judiciously considered in these patients; these procedures typically require multidisciplinary pre- and postoperative evaluation and care over lengthy hospital stays with a high risk of respiratory complications that bear consideration in treatment planning.

An Assessment of the Quality of Life of Patients With Class III Deformities Treated With Orthognathic Surgery

To evaluate quality of life (QoL) from a broad perspective by a comparison of Turkish patients undergoing orthognathic surgery to correct Angle Class III skeletal deformity with a control group composed of participants without dentofacial deformity using general health, generic oral health, and condition-specific QoL approaches. Thirty patients who underwent orthognathic surgery to correct Class III relations (monomaxillary and bimaxillary groups) and 30 participants with Class I skeletal structure and good dentofacial harmony (control group) were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), generic oral health-related QoL through a 14-item Short-Form Oral Health Impact Profile (OHIP-14), and generic health-related QoL through a 36-item Short-Form Health Survey (SF-36) were assessed. When the groups were compared, OQLQ scores showed a significant difference in the oral function domain only in the bimaxillary group (P < .05), and OHIP-14 scores showed significant differences in half the OHIP-14 subscale scores in the monomaxillary and bimaxillary groups (P < .05). The SF-36 scores showed significant differences only for the vitality domain in the monomaxillary group and the vitality and mental health domains in the bimaxillary group (P < .05). For condition-specific and health-related QoL, the QoL of orthognathic surgical patients appeared to be similar to that of participants without dentofacial deformities. Oral health-related QoL of orthognathic surgical patients seemed moderately similar to that of participants without dentofacial deformities. The combined use of these methods is helpful for evaluating QoL from a larger perspective.

A Comparative Study of the Changes in Condylar Position after Mandibular Setback Using Bilateral Sagittal Split Ramus Osteotomy between Surgery-After and Surgery-First Orthognathic Surgery

Statement of the Problem: Complication after Extraoral Vertical and Intraoral Oblique Osteotomy have been reported but in a comprehensive manner. Although intuitively the profile of complications after Intra Oral Vertical Ramus Osteotomy (IVRO) would be similar to subcondylar osteotomy, the technique of the two procedures are different, and thus unfavorable outcome after surgery also may differ. The aim of this study was evaluate the morbidity and complications following correcton of mandibular deformity by IVRO. Material and Method: A prospective study was undertaken of 271 consecutively treated orthognathic surgical patients with mandibular deformity(without mandibular deficiency). Each patients was treated by bilateral IVRO with 2 Weeks of maxillo-mandibular fixation and no interosseous fixation of proximal segment. Method of Data Analysis: Postoperative stability ,immediately after surgery ,at 6 months , and at 12 months after surgeryweremade. Complications consist of vascular complications, nerve injury, infection, condylar luxation andbonehearingwere assessedby retrospective individual chart review. Results: The mean blood loss was 47g and no severe bleeding during operation. There was no wound infection and avascular necrosis after surgery. Inferior alveolar nerve neurosensory disturbance remained 2 operative sites but was not permanent. Malocclusion after surgery was manifest by either relapse or anterior open bite occurred in 3 patients. Condylar dislocation occurred 1 patient. Conclusion: Our studies indicated that surgical correction of mandibular deformity by IVRO had a beneficial effect not only on occlusion but also upon complication after surgery.

Postoperative Gastrointestinal Bleeding in Orthognathic Surgery Patients: Its Estimated Prevalence and Possible Association to Known Risk Factors

To assess the prevalence of gastrointestinal (GI) bleeding in patients after orthognathic surgery and its relation to known risk factors. With institutional review board approval, a single-center case series was conducted with data collected retrospectively from orthognathic surgical patients' medical records from 1990 to 2010. All patients were treated by 1 primary surgeon, were limited to 21 years or younger at the time of surgery, and had no coagulopathy. The authors' hypothesis was that patients concurrently exposed to mechanical ventilation and dual anti-inflammatory drugs in the postoperative period would be at a greater risk for clinically significant GI bleeding according to the American Society of Health-System Pharmacists guideline compared with those exposed to fewer risk factors. Its prevalence and relation to known risk factors were analyzed. In total 498 orthognathic cases consisting of 220 male patients (median age, 17 yr; age range, 3to 21 yr) and 262 female patients (median age, 17 yr; age range, 10 to 21 yr) were reviewed. Of 17 patients admitted to intensive care unit level of care postoperatively, 4 patients were exposed to concomitant administration of ketorolac and steroids while being mechanically ventilated. Two of these 4 patients developed esophagogastroduodenoscopy-confirmed upper GI bleeding (UGIB). There was no incidence of UGIB in patients not exposed to all 3 risk factors concurrently. Postoperative GI bleeding complication is rare in orthognathic surgical patients, with an estimated prevalence of 0.4%. Based on these observations, orthognathic surgical patients who require mechanical ventilation and are receiving anti-inflammatory medications may have an increased risk of GI bleeding. In the absence of active bleeding from the surgical site, persistent decrease in hemoglobin concentration should alert one to consider the possibility of UGIB.

Reliability of Hard-and Soft-tissue Computer-generated Predictions of Orthognathic Surgical Patients using VistaDent Software

Reliability of Hard-and Soft-tissue Computer-generated Predictions of Orthognathic Surgical Patients using VistaDent Software